Healthcare Provider Details

I. General information

NPI: 1053562132
Provider Name (Legal Business Name): MARC R. MIYASAKI M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S BERETANIA ST SUITE 605
HONOLULU HI
96813-2414
US

IV. Provider business mailing address

550 S BERETANIA ST SUITE 605
HONOLULU HI
96813-2414
US

V. Phone/Fax

Practice location:
  • Phone: 808-548-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MARC ROBERT MIYASAKI
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 808-226-6853