Provider Demographics
NPI:1023003779
Name:MIURA, CORIE AKI (MS CCC A)
Entity Type:Individual
Prefix:MS
First Name:CORIE
Middle Name:AKI
Last Name:MIURA
Suffix:
Gender:F
Credentials:MS CCC A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92-128 AMAUI PL
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2319
Mailing Address - Country:US
Mailing Address - Phone:808-672-5482
Mailing Address - Fax:
Practice Address - Street 1:99-115 AIEA HEIGHTS DR
Practice Address - Street 2:#264
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3924
Practice Address - Country:US
Practice Address - Phone:808-486-5000
Practice Address - Fax:808-486-5007
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAUD104231H00000X
HIHA133237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI100433Medicare ID - Type Unspecified
Q44089Medicare UPIN