Provider Demographics
NPI:1073019162
Name:LEON MATSUO MD INC
Entity Type:Organization
Organization Name:LEON MATSUO MD INC
Other - Org Name:KUKUI LIFESTYLE MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEON
Authorized Official - Middle Name:
Authorized Official - Last Name:MATSUO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-382-0754
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:CAPTAIN COOK
Mailing Address - State:HI
Mailing Address - Zip Code:96704-0312
Mailing Address - Country:US
Mailing Address - Phone:808-825-6557
Mailing Address - Fax:
Practice Address - Street 1:82-6066 MAMALAHOA HWY STE 14
Practice Address - Street 2:
Practice Address - City:CAPTAIN COOK
Practice Address - State:HI
Practice Address - Zip Code:96704-8204
Practice Address - Country:US
Practice Address - Phone:808-825-6557
Practice Address - Fax:808-731-6511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-05
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD16101207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty