Provider Demographics
NPI:1720006810
Name:YAMAGUCHI, JON STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:STEVEN
Last Name:YAMAGUCHI
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 1:550 S BERETANIA ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2414
Mailing Address - Country:US
Mailing Address - Phone:808-523-5033
Mailing Address - Fax:808-528-4713
Practice Address - Street 1:550 S BERETANIA ST
Practice Address - Street 2:SUITE 403
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2414
Practice Address - Country:US
Practice Address - Phone:808-523-5033
Practice Address - Fax:808-528-4713
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056250204F00000X
VT042-0011342204F00000X
HI17065204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA3985266OtherAETNA HMO
GA930180OtherBLUE SHIELD
GA2549145OtherUNITED HEALTHCARE OF GA
GA582030692OtherCIGNA PPO
GA6799024001OtherCIGNA HMO
GA7553699OtherAETNA PPO
GA186165877BOtherWELFARE ID
GAY 20050801OtherPRIVATEHEALTHCARE SYSTEMS
GA930180OtherBLUE SHIELD
GA19798A001Medicare UPIN
GAP00283385Medicare ID - Type UnspecifiedRAILROAD MEDICARE