Provider Demographics
NPI:1568532992
Name:YATES, JAMES TRAVIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:TRAVIS
Last Name:YATES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 POLIHALE PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-2121
Mailing Address - Country:US
Mailing Address - Phone:808-486-5000
Mailing Address - Fax:808-486-5007
Practice Address - Street 1:99-115 AIEA HEIGHTS DR
Practice Address - Street 2:SUITE 264
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3924
Practice Address - Country:US
Practice Address - Phone:808-486-5000
Practice Address - Fax:808-486-5007
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHI 038231H00000X
HIHI 134237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI038OtherAUDIOLOGY LICENSE
HIHA134OtherFIT DISPENSE
HIA042604Medicaid
HI0000VCBBSMedicare ID - Type Unspecified
HIA042604Medicaid