Provider Demographics
NPI:1285660696
Name:WAKUZAWA, WYNN T (MD)
Entity Type:Individual
Prefix:MR
First Name:WYNN
Middle Name:T
Last Name:WAKUZAWA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:770 KAPIOLANI BLVD
Mailing Address - Street 2:#705
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5212
Mailing Address - Country:US
Mailing Address - Phone:808-597-8791
Mailing Address - Fax:808-597-8781
Practice Address - Street 1:1301 PUNCHBOWL ST
Practice Address - Street 2:EMERGENCY DEPARTMENT, QUEEN'S MEDICAL CENTER
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2402
Practice Address - Country:US
Practice Address - Phone:808-597-8791
Practice Address - Fax:808-597-8781
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
HIMD6155207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI06878202Medicaid
HI01WCCFH10Medicare ID - Type Unspecified
HIE86579Medicare UPIN