Healthcare Provider Details

I. General information

NPI: 1215973029
Provider Name (Legal Business Name): KAREN C. YAMAGUCHI DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 PIIKOI ST SUITE 1401
HONOLULU HI
96814-3116
US

IV. Provider business mailing address

615 PIIKOI ST SUITE 1401
HONOLULU HI
96814-3116
US

V. Phone/Fax

Practice location:
  • Phone: 808-591-0020
  • Fax: 808-591-0080
Mailing address:
  • Phone: 808-591-0020
  • Fax: 808-591-0080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1528
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number123
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: