Healthcare Provider Details

I. General information

NPI: 1659434025
Provider Name (Legal Business Name): CALVIN M. MIURA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 SOUTH KING STREET SUITE 1001
HONOLULU HI
96814
US

IV. Provider business mailing address

1150 SOUTH KING STREET SUITE 1001
HONOLULU HI
96814
US

V. Phone/Fax

Practice location:
  • Phone: 808-947-2233
  • Fax: 808-944-0930
Mailing address:
  • Phone: 808-947-2233
  • Fax: 808-944-0930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD2077
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: