Healthcare Provider Details

I. General information

NPI: 1497666960
Provider Name (Legal Business Name): CHEYENNE YAMADA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47-164 PULAMA RD
KANEOHE HI
96744-5023
US

IV. Provider business mailing address

47-164 PULAMA RD
KANEOHE HI
96744-5023
US

V. Phone/Fax

Practice location:
  • Phone: 808-321-2642
  • Fax:
Mailing address:
  • Phone: 808-321-2642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number6447
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: