=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144356783
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROY M MATSUYAMA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2007
-----------------------------------------------------
Last Update Date | 02/03/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 173 HOOHANA ST SUITE 104
-----------------------------------------------------
City | KAHULUI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96732-2482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-871-7222
-----------------------------------------------------
Fax | 808-871-2222
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 173 HOOHANA ST SUITE 104
-----------------------------------------------------
City | KAHULUI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96732-2482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-871-7222
-----------------------------------------------------
Fax | 808-871-2222
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 17851
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------