Provider Demographics
NPI:1821059353
Name:YOST, FREDRICK LEWIS (MD)
Entity Type:Individual
Prefix:
First Name:FREDRICK
Middle Name:LEWIS
Last Name:YOST
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 1:1508 LEHIA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-1829
Mailing Address - Country:US
Mailing Address - Phone:808-421-9678
Mailing Address - Fax:808-423-1109
Practice Address - Street 1:405 N KUAKINI ST
Practice Address - Street 2:SUITE 601
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-6300
Practice Address - Country:US
Practice Address - Phone:808-536-5811
Practice Address - Fax:808-596-0370
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-01
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI8791208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI25296601Medicaid
HI218156OtherHMSA
HI218156OtherHMSA