Healthcare Provider Details

I. General information

NPI: 1538508452
Provider Name (Legal Business Name): KEISUKE MIYAMOTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 N KUAKINI ST
HONOLULU HI
96817-2306
US

IV. Provider business mailing address

PO BOX 12176
HONOLULU HI
96828-1176
US

V. Phone/Fax

Practice location:
  • Phone: 808-536-2236
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD18539
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD18539
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: