Healthcare Provider Details

I. General information

NPI: 1386634202
Provider Name (Legal Business Name): DR. WALTER UYESUGI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KEAHOLE PL # 1218
HONOLULU HI
96825-3415
US

IV. Provider business mailing address

7938 HAWAII KAI DR
HONOLULU HI
96825-2856
US

V. Phone/Fax

Practice location:
  • Phone: 808-395-3983
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberDOS826
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036121888
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA-1490-09
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: