Provider Demographics
NPI:1568064988
Name:KENSON MIYAKI DPM LLC
Entity Type:Organization
Organization Name:KENSON MIYAKI DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:KENSON
Authorized Official - Middle Name:T
Authorized Official - Last Name:MIYAKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:808-979-4482
Mailing Address - Street 1:1029 KAPAHULU AVE STE 306B
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-1332
Mailing Address - Country:US
Mailing Address - Phone:808-979-4482
Mailing Address - Fax:
Practice Address - Street 1:1029 KAPAHULU AVE STE 306B
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-1332
Practice Address - Country:US
Practice Address - Phone:808-291-8298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-10
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric