Provider Demographics
NPI:1588177190
Name:DOUGLAS H. YAMASHITA, M.D. INC
Entity Type:Organization
Organization Name:DOUGLAS H. YAMASHITA, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:YAMASHITA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-935-7181
Mailing Address - Street 1:1276 KINOOLE ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4135
Mailing Address - Country:US
Mailing Address - Phone:808-935-7181
Mailing Address - Fax:808-935-6332
Practice Address - Street 1:1276 KINOOLE ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4135
Practice Address - Country:US
Practice Address - Phone:808-935-7181
Practice Address - Fax:808-935-6332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-06
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5571207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02336301Medicaid