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General NPI Number Information
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NPI Number | 1760612329
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Entity Type | Organization
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Legal Business Name | SUSAN MIKAMI MD LLC
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Dates
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Enumeration Date | 07/16/2009
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Last Update Date | 07/28/2009
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Provider Practice Location Address
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Address Line | 1100 WARD AVE SUITE 810
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City | HONOLULU
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State | HI
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Zip | 96814-1600
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Country | US
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Telephone | 808-351-1012
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10012
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City | HONOLULU
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State | HI
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Zip | 96816-0012
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Country | US
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Telephone | 808-351-1012
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Fax |
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Authorized Official
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Title or Position | AGENT
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Name | DR. SUSAN MIKAMI
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Credential | M.D.
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Telephone | 808-351-1012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 13933
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 13933
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License Number State | HI
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 13933
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License Number State | HI
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