Healthcare Provider Details

I. General information

NPI: 1942934039
Provider Name (Legal Business Name): YUSUKE MIYATANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1356 LUSITANA ST
HONOLULU HI
96813-2409
US

IV. Provider business mailing address

1356 LUSITANA ST FL 7
HONOLULU HI
96813-2409
US

V. Phone/Fax

Practice location:
  • Phone: 808-586-2898
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number125.079181
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMDR-8752-0
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: