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General NPI Number Information
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NPI Number | 1841431400
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Entity Type | Individual
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Provider Name | ERIC MITSUO YUKUMOTO PA-C
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Gender | Male
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Dates
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Enumeration Date | 03/11/2009
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 550 S BERETANIA ST STE 603
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City | HONOLULU
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State | HI
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Zip | 96813-2496
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Country | US
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Telephone | 808-447-7454
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Fax | 808-447-7456
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Provider Business Mailing Address
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Address Line | 550 S BERETANIA ST STE 603
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City | HONOLULU
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State | HI
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Zip | 96813-2496
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Country | US
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Telephone | 808-447-7454
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Fax | 808-447-7456
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | AMD-348
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License Number State | HI
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