Healthcare Provider Details

I. General information

NPI: 1861752875
Provider Name (Legal Business Name): MYLES SUEHIRO, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 KAPIOLANI BLVD SUITE 1645
HONOLULU HI
96814-4522
US

IV. Provider business mailing address

3784 KUMULANI PL
HONOLULU HI
96822-1112
US

V. Phone/Fax

Practice location:
  • Phone: 808-312-1256
  • Fax: 808-988-5090
Mailing address:
  • Phone: 808-372-5111
  • Fax: 808-988-5090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number3777
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number3777
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number3777
License Number StateHI

VIII. Authorized Official

Name: DR. MYLES SUEHIRO
Title or Position: OWNER
Credential: M.D.
Phone: 808-372-5111