Provider Demographics
NPI:1528200060
Name:YAMAMOTO, KELVIN YOSHITO
Entity Type:Individual
Prefix:MR
First Name:KELVIN
Middle Name:YOSHITO
Last Name:YAMAMOTO
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 1:193 S HOTEL ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2805
Mailing Address - Country:US
Mailing Address - Phone:808-536-1466
Mailing Address - Fax:808-526-1031
Practice Address - Street 1:193 S HOTEL ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2805
Practice Address - Country:US
Practice Address - Phone:808-536-1466
Practice Address - Fax:808-526-1031
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDIO-178156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician