Healthcare Provider Details

I. General information

NPI: 1013019702
Provider Name (Legal Business Name): CYNTHIA CHIEMI YASUDA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 PATTERSON RD 122
HONOLULU HI
96819-1522
US

IV. Provider business mailing address

343 HOBRON LN #903
HONOLULU HI
96815-1028
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-7648
  • Fax: 808-433-0398
Mailing address:
  • Phone: 808-433-7648
  • Fax: 808-433-0398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW167
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: