Provider Demographics
NPI:1366450330
Name:ISHII, CLYDE H JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:H
Last Name:ISHII
Suffix:JR
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 1:1329 LUSITANA ST STE 304
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2411
Mailing Address - Country:US
Mailing Address - Phone:808-537-6630
Mailing Address - Fax:808-536-4084
Practice Address - Street 1:1329 LUSITANA ST STE 304
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2411
Practice Address - Country:US
Practice Address - Phone:808-537-6630
Practice Address - Fax:808-536-4084
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5352174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH0000BDRWGMedicare ID - Type Unspecified
HID43447Medicare UPIN