Provider Demographics
NPI:1821006933
Name:YAMADA, GREGG M (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:M
Last Name:YAMADA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:MAILCODE 47866
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96807-1300
Mailing Address - Country:US
Mailing Address - Phone:808-522-7222
Mailing Address - Fax:808-532-0414
Practice Address - Street 1:550 S BERETANIA ST
Practice Address - Street 2:SUITE 601
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2496
Practice Address - Country:US
Practice Address - Phone:808-522-7222
Practice Address - Fax:808-532-0414
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HIMD7463207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07757102Medicaid
HI07757102Medicaid
HI52716Medicare ID - Type Unspecified