Healthcare Provider Details

I. General information

NPI: 1821059353
Provider Name (Legal Business Name): FREDRICK LEWIS YOST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2006
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N KUAKINI ST SUITE 601
HONOLULU HI
96817-6300
US

IV. Provider business mailing address

1508 LEHIA ST
HONOLULU HI
96818-1829
US

V. Phone/Fax

Practice location:
  • Phone: 808-536-5811
  • Fax: 808-596-0370
Mailing address:
  • Phone: 808-421-9678
  • Fax: 808-423-1109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number8791
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: