Healthcare Provider Details

I. General information

NPI: 1225236995
Provider Name (Legal Business Name): BARRY MIKIO MIZUO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST STE 512
HONOLULU HI
96826-1072
US

IV. Provider business mailing address

2240 MOHALA WAY
HONOLULU HI
96822-1963
US

V. Phone/Fax

Practice location:
  • Phone: 808-983-8736
  • Fax:
Mailing address:
  • Phone: 562-787-1035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA93151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: