Provider Demographics
NPI:1275893109
Name:YEPISHIN, ILYA VLADIMIR (DO)
Entity Type:Individual
Prefix:DR
First Name:ILYA
Middle Name:VLADIMIR
Last Name:YEPISHIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 HAWAII ST
Mailing Address - Street 2:APT. A
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-7327
Mailing Address - Country:US
Mailing Address - Phone:310-408-2891
Mailing Address - Fax:844-656-5581
Practice Address - Street 1:736 HAWAII ST
Practice Address - Street 2:APT. A
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-7327
Practice Address - Country:US
Practice Address - Phone:310-408-2891
Practice Address - Fax:844-656-5581
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
HIDOS-1673207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program