Provider Demographics
NPI:1598749640
Name:OYAMA, IAN (MD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:
Last Name:OYAMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 PUNAHOU ST
Mailing Address - Street 2:STE 824
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1001
Mailing Address - Country:US
Mailing Address - Phone:808-203-6519
Mailing Address - Fax:808-955-2174
Practice Address - Street 1:1319 PUNAHOU ST
Practice Address - Street 2:STE 801
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1001
Practice Address - Country:US
Practice Address - Phone:808-949-5305
Practice Address - Fax:808-955-2174
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD11095207V00000X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI568595Medicaid
HI568595Medicaid
H69049Medicare UPIN