Provider Demographics
NPI:1851336978
Name:SUMIDA, RYAN NOBUO (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:NOBUO
Last Name:SUMIDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:99-128 AIEA HEIGHTS DR
Mailing Address - Street 2:SUITE 211
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3925
Mailing Address - Country:US
Mailing Address - Phone:808-488-8441
Mailing Address - Fax:808-487-2003
Practice Address - Street 1:99-128 AIEA HEIGHTS DR
Practice Address - Street 2:SUITE 211
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3925
Practice Address - Country:US
Practice Address - Phone:808-488-8441
Practice Address - Fax:808-487-2003
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD-5450208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI022098-01Medicaid