Healthcare Provider Details

I. General information

NPI: 1235334947
Provider Name (Legal Business Name): LEON MATSUO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82-6066 MAMALAHOA HWY STE 14
CAPTAIN COOK HI
96704-8204
US

IV. Provider business mailing address

PO BOX 312
CAPTAIN COOK HI
96704-0312
US

V. Phone/Fax

Practice location:
  • Phone: 808-825-6557
  • Fax: 808-731-6511
Mailing address:
  • Phone: 808-825-6557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-16101
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-16101
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: