Provider Demographics
NPI:1275502130
Name:MIYAMOTO, ROBIN EMI SUGIHARA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:EMI SUGIHARA
Last Name:MIYAMOTO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 LILIHA ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1600
Mailing Address - Country:US
Mailing Address - Phone:808-531-5711
Mailing Address - Fax:808-531-5722
Practice Address - Street 1:2226 LILIHA ST
Practice Address - Street 2:SUITE 306
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1600
Practice Address - Country:US
Practice Address - Phone:808-531-5711
Practice Address - Fax:808-531-5722
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-749103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI506892-01Medicaid
HI55381Medicare ID - Type Unspecified