Healthcare Provider Details

I. General information

NPI: 1871291880
Provider Name (Legal Business Name): MICAH YAMADA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 05/24/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 PUNAHOU ST
HONOLULU HI
96826-1031
US

IV. Provider business mailing address

94-017 KUAHELANI AVE APT 146
MILILANI HI
96789-1657
US

V. Phone/Fax

Practice location:
  • Phone: 808-678-8467
  • Fax: 808-745-1545
Mailing address:
  • Phone: 808-754-1037
  • Fax: 808-745-1545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC-1560-0
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: