Healthcare Provider Details

I. General information

NPI: 1568836195
Provider Name (Legal Business Name): ELAINE TSUKAYAMA, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 LUSITANA ST STE 907
HONOLULU HI
96813-2449
US

IV. Provider business mailing address

848 S BERETANIA ST STE. 400
HONOLULU HI
96813-2551
US

V. Phone/Fax

Practice location:
  • Phone: 808-524-2885
  • Fax: 808-524-2886
Mailing address:
  • Phone: 808-536-0314
  • Fax: 808-536-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-17743
License Number StateHI

VIII. Authorized Official

Name: DR. ELAINE TSUKAYAMA
Title or Position: OWNER
Credential: M.D.
Phone: 808-524-2885