Provider Demographics
NPI:1790042281
Name:YAMAMOTO, ANNIE CHAO-AN YUNG
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:CHAO-AN YUNG
Last Name:YAMAMOTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 S KING ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2114
Mailing Address - Country:US
Mailing Address - Phone:808-591-8402
Mailing Address - Fax:808-591-8408
Practice Address - Street 1:1030 S KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2114
Practice Address - Country:US
Practice Address - Phone:808-591-8402
Practice Address - Fax:808-591-8408
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH3718183500000X
WAIR 60181873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist