Healthcare Provider Details

I. General information

NPI: 1811213523
Provider Name (Legal Business Name): KOJI IIZUKA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 NUUANU AVE LOWR LEVEL
HONOLULU HI
96817-5193
US

IV. Provider business mailing address

ATTN: ABS P.O. BOX 60599
EWA BEACH HI
96706
US

V. Phone/Fax

Practice location:
  • Phone: 808-728-6618
  • Fax: 808-215-4255
Mailing address:
  • Phone: 808-664-1104
  • Fax: 866-592-3149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberEMTL-2020-023
License Number StateGU
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number16581
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: