Healthcare Provider Details

I. General information

NPI: 1376599423
Provider Name (Legal Business Name): RYAN T MATSUO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PUNCHBOWL ST
HONOLULU HI
96813-2402
US

IV. Provider business mailing address

500 ALA MOANA BLVD TOWER 4, SUITE 510
HONOLULU HI
96813-4920
US

V. Phone/Fax

Practice location:
  • Phone: 808-521-9551
  • Fax: 808-536-3008
Mailing address:
  • Phone: 808-521-9551
  • Fax: 808-536-3008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD-9168
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: