Provider Demographics
NPI:1821325689
Name:MIYAKE, LEIGHTON AKIRA
Entity Type:Individual
Prefix:
First Name:LEIGHTON
Middle Name:AKIRA
Last Name:MIYAKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 PROSPECT ST APT 1015
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-3449
Mailing Address - Country:US
Mailing Address - Phone:808-497-9086
Mailing Address - Fax:
Practice Address - Street 1:1013 PROSPECT ST APT 1015
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-3449
Practice Address - Country:US
Practice Address - Phone:808-497-9086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-14
Last Update Date:2009-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health