Healthcare Provider Details

I. General information

NPI: 1487755583
Provider Name (Legal Business Name): KENT SATOSHI YAMAMOTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 N KUAKINI ST
HONOLULU HI
96817-2421
US

IV. Provider business mailing address

500 ALA MOANA BLVD STE 2-200
HONOLULU HI
96813-4993
US

V. Phone/Fax

Practice location:
  • Phone: 808-544-3368
  • Fax: 808-535-1572
Mailing address:
  • Phone: 808-628-1652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number13878
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: