Healthcare Provider Details

I. General information

NPI: 1396134508
Provider Name (Legal Business Name): KAREN C. YAMAGUCHI, DPM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 PIIKOI ST STE 1401
HONOLULU HI
96814-3189
US

IV. Provider business mailing address

1557 ALA LANI ST
HONOLULU HI
96819-1444
US

V. Phone/Fax

Practice location:
  • Phone: 808-591-0020
  • Fax: 808-591-0080
Mailing address:
  • Phone: 956-337-9512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO123
License Number StateHI

VIII. Authorized Official

Name: KAREN C YAMAGUCHI
Title or Position: MEMBER
Credential: DPM
Phone: 956-337-9512