Healthcare Provider Details

I. General information

NPI: 1336116706
Provider Name (Legal Business Name): MICHELLE H. MIYASHIRO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 LILIHA ST #105
HONOLULU HI
96817-3169
US

IV. Provider business mailing address

1329 LUSITANA ST #307
HONOLULU HI
96813-2429
US

V. Phone/Fax

Practice location:
  • Phone: 808-524-3131
  • Fax: 808-524-3189
Mailing address:
  • Phone: 808-524-6115
  • Fax: 808-528-1711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD12484
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: