Healthcare Provider Details

I. General information

NPI: 1457392029
Provider Name (Legal Business Name): CLYDE T MIYAKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 KAPAHULU AVE 301
HONOLULU HI
96816-1332
US

IV. Provider business mailing address

1029 KAPAHULU AVE 301
HONOLULU HI
96816-1332
US

V. Phone/Fax

Practice location:
  • Phone: 808-733-5111
  • Fax: 808-733-5122
Mailing address:
  • Phone: 808-733-5111
  • Fax: 808-733-5122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD-3994
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: