Healthcare Provider Details

I. General information

NPI: 1699965699
Provider Name (Legal Business Name): KOICHIRO YAMASAKI MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 N KUAKINI ST, MPH-9
HONOLULU HI
96817
US

IV. Provider business mailing address

347 N KUAKINI ST, MPH-9
HONOLULU HI
96817
US

V. Phone/Fax

Practice location:
  • Phone: 808-523-8461
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD14029
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: