Provider Demographics
NPI:1083810642
Name:IIDA-TAKASHIMA, MALISSA HYUN KYUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:MALISSA
Middle Name:HYUN KYUNG
Last Name:IIDA-TAKASHIMA
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 1:98-1079 MOANALUA RD
Mailing Address - Street 2:STE 500
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4713
Mailing Address - Country:US
Mailing Address - Phone:808-488-0990
Mailing Address - Fax:
Practice Address - Street 1:98-1079 MOANALUA RD
Practice Address - Street 2:STE 500
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4713
Practice Address - Country:US
Practice Address - Phone:808-488-0990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMDR5282207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine