Healthcare Provider Details

I. General information

NPI: 1922569441
Provider Name (Legal Business Name): KEOLAMAU SIU LIN YEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1079 MOANALUA RD STE 500
AIEA HI
96701-4794
US

IV. Provider business mailing address

98-1079 MOANALUA RD
AIEA HI
96701-4713
US

V. Phone/Fax

Practice location:
  • Phone: 808-488-0990
  • Fax:
Mailing address:
  • Phone: 808-488-0990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number22457
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: