Healthcare Provider Details

I. General information

NPI: 1316931314
Provider Name (Legal Business Name): GILBERT KOJI YAMAMOTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N KUAKINI ST SUITE 1106
HONOLULU HI
96817-6300
US

IV. Provider business mailing address

405 N KUAKINI ST SUITE 1106
HONOLULU HI
96817-6300
US

V. Phone/Fax

Practice location:
  • Phone: 808-531-5993
  • Fax: 808-534-4974
Mailing address:
  • Phone: 808-531-5993
  • Fax: 808-534-4974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD-3528
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: