MEDICARE: MARISSA MIYAGI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MDR-9210	HI

General Provider Information

NPI Number	:	1316882798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA MIYAGI MD

Provider Business Mailing Address
First Line	:	1356 LUSITANA ST FL 6
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96813-2409
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1356 LUSITANA ST FL 6
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96813-2409
Country	:	US
Telephone Number	:	808-691-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2026
Last Update Date	:	04/21/2026

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