Provider Demographics
NPI:1497790281
Name:UYTINGCO, MYRNA S (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRNA
Middle Name:S
Last Name:UYTINGCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-2135 FORT WEAVER RD STE 150
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-1929
Mailing Address - Country:US
Mailing Address - Phone:808-691-3150
Mailing Address - Fax:
Practice Address - Street 1:91-2135 FORT WEAVER RD STE 150
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-1929
Practice Address - Country:US
Practice Address - Phone:808-691-3150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-13833207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A848130Medicaid
CAWA84813BMedicare PIN
CA00A848130Medicaid