Healthcare Provider Details

I. General information

NPI: 1295021657
Provider Name (Legal Business Name): CHRISTIE H IZUTSU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2228 LILIHA ST STE 200
HONOLULU HI
96817-1652
US

IV. Provider business mailing address

2228 LILIHA ST STE 200
HONOLULU HI
96817-1652
US

V. Phone/Fax

Practice location:
  • Phone: 808-533-3130
  • Fax: 808-533-3140
Mailing address:
  • Phone: 808-533-3130
  • Fax: 808-533-3140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number18722
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA123932
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: