Provider Demographics
NPI:1639157365
Name:SMITH, RYAN MICHAEL (DO, FACC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MICHAEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JARRETT WHITE ROAD
Mailing Address - Street 2:DEPARTMENT OF MEDICINE
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96859
Mailing Address - Country:US
Mailing Address - Phone:808-433-5119
Mailing Address - Fax:
Practice Address - Street 1:46-001 KAMEHAMEHA HWY STE 212
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3728
Practice Address - Country:US
Practice Address - Phone:808-636-6393
Practice Address - Fax:866-573-0778
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1156207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease