Provider Demographics
NPI:1467547307
Name:TATSUNO, SYDNEY Y (MD)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:Y
Last Name:TATSUNO
Suffix:
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 1:868 ULULANI ST
Mailing Address - Street 2:STE 102
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3913
Mailing Address - Country:US
Mailing Address - Phone:808-969-1671
Mailing Address - Fax:808-969-7557
Practice Address - Street 1:868 ULULANI ST
Practice Address - Street 2:STE 102
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3913
Practice Address - Country:US
Practice Address - Phone:808-969-1671
Practice Address - Fax:808-969-7557
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD4671207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIA17028OtherHMSA
HI01585001Medicaid
HI01585001Medicaid
HI0000BDKTJMedicare ID - Type Unspecified