Provider Demographics
NPI:1225236995
Name:MIZUO, BARRY MIKIO (MD)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:MIKIO
Last Name:MIZUO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 MOHALA WAY
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1963
Mailing Address - Country:US
Mailing Address - Phone:562-787-1035
Mailing Address - Fax:
Practice Address - Street 1:1319 PUNAHOU ST STE 512
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1072
Practice Address - Country:US
Practice Address - Phone:808-983-8736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93151208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics