Provider Demographics
NPI:1215382932
Name:MICHAELSON, ASAKO MIYAZAKI (BS,MAT-13954)
Entity Type:Individual
Prefix:MRS
First Name:ASAKO
Middle Name:MIYAZAKI
Last Name:MICHAELSON
Suffix:
Gender:F
Credentials:BS,MAT-13954
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 HONE ST
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-1421
Mailing Address - Country:US
Mailing Address - Phone:808-250-8177
Mailing Address - Fax:
Practice Address - Street 1:221 PIIKEA AVE
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8268
Practice Address - Country:US
Practice Address - Phone:808-268-2684
Practice Address - Fax:866-799-7374
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-13954171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor