Provider Demographics
NPI:1386634202
Name:UYESUGI, WALTER
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:
Last Name:UYESUGI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KEAHOLE PL
Mailing Address - Street 2:# 1218
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-3415
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 KEAHOLE PL
Practice Address - Street 2:# 1218
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-3415
Practice Address - Country:US
Practice Address - Phone:808-395-3983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS8262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology