Provider Demographics
NPI:1952495319
Name:BUNN, MIKIKO YAZAWA (MD)
Entity Type:Individual
Prefix:DR
First Name:MIKIKO
Middle Name:YAZAWA
Last Name:BUNN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-151 PALI MOMI ST
Mailing Address - Street 2:STRAUB CLINIC PEARLRIDGE
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4300
Mailing Address - Country:US
Mailing Address - Phone:808-483-6400
Mailing Address - Fax:808-483-6489
Practice Address - Street 1:98-151 PALI MOMI ST
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4300
Practice Address - Country:US
Practice Address - Phone:808-483-6400
Practice Address - Fax:808-483-6489
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-13217207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HII42693Medicare UPIN