Provider Demographics
NPI:1457313736
Name:NISHIMURA, GWENDOLYN YUEN (MD)
Entity Type:Individual
Prefix:DR
First Name:GWENDOLYN
Middle Name:YUEN
Last Name:NISHIMURA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GWENDOLYN
Other - Middle Name:YUK LAN
Other - Last Name:YUEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1584A HANAI LOOP
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1801
Mailing Address - Country:US
Mailing Address - Phone:808-847-3878
Mailing Address - Fax:
Practice Address - Street 1:480 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PEARL HARBOR
Practice Address - State:HI
Practice Address - Zip Code:96860-4908
Practice Address - Country:US
Practice Address - Phone:808-471-8956
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD3345207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine