Healthcare Provider Details

I. General information

NPI: 1114138450
Provider Name (Legal Business Name): KELLY YAMASATO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST STE 824
HONOLULU HI
96826
US

IV. Provider business mailing address

1319 PUNAHOU ST STE 824
HONOLULU HI
96826-1032
US

V. Phone/Fax

Practice location:
  • Phone: 808-203-6500
  • Fax:
Mailing address:
  • Phone: 808-203-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4767
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD-15082
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number15082
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: