Provider Demographics
NPI:1528183217
Name:YATSUSHIRO, GUY NATHAN (MD)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:NATHAN
Last Name:YATSUSHIRO
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 1:1914 SOUTH KING STREET
Mailing Address - Street 2:#201
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826
Mailing Address - Country:US
Mailing Address - Phone:808-946-7159
Mailing Address - Fax:808-946-7158
Practice Address - Street 1:1914 SOUTH KING STREET
Practice Address - Street 2:#201
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826
Practice Address - Country:US
Practice Address - Phone:808-946-7159
Practice Address - Fax:808-946-7158
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4722207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01535501Medicaid
C98989Medicare UPIN
HI01535501Medicaid