Provider Demographics
NPI:1538283098
Name:KUSAKA, YUKO SHIBANO (MD)
Entity Type:Individual
Prefix:DR
First Name:YUKO
Middle Name:SHIBANO
Last Name:KUSAKA
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 1:3328 KAHAWALU DR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1024
Mailing Address - Country:US
Mailing Address - Phone:808-595-0627
Mailing Address - Fax:
Practice Address - Street 1:1221 KAPIOLANI BLVD STE 830
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3515
Practice Address - Country:US
Practice Address - Phone:808-593-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD66982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000BDWSSMedicare ID - Type Unspecified