Provider Demographics
NPI:1447465869
Name:YAMAMOTO, IZUMI (MD)
Entity type:Individual
Prefix:
First Name:IZUMI
Middle Name:
Last Name:YAMAMOTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE 1503
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814
Mailing Address - Country:US
Mailing Address - Phone:808-943-7000
Mailing Address - Fax:808-943-7001
Practice Address - Street 1:1441 KAPIOLANI BLVD
Practice Address - Street 2:SUITE 1503
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814
Practice Address - Country:US
Practice Address - Phone:808-943-7000
Practice Address - Fax:808-943-7001
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2010-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99096207W00000X
HIMD-15294207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A9909600OtherBLUE SHIELD
CAWA99096BMedicare PIN