Healthcare Provider Details

I. General information

NPI: 1740924596
Provider Name (Legal Business Name): YURI KOROBCHUK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N KUAKINI ST
HONOLULU HI
96817-2364
US

IV. Provider business mailing address

1211 MEDICAL CENTER DR
NASHVILLE TN
37232-0004
US

V. Phone/Fax

Practice location:
  • Phone: 808-792-9888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDOS-2918-0
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: