Provider Demographics
NPI:1336203363
Name:BHASKAR, YASHODA (MD)
Entity Type:Individual
Prefix:DR
First Name:YASHODA
Middle Name:
Last Name:BHASKAR
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 1:73-1225 KAUILANIAKEA DR
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-7600
Mailing Address - Country:US
Mailing Address - Phone:808-989-6318
Mailing Address - Fax:
Practice Address - Street 1:65-1241 POMAIKAI PL
Practice Address - Street 2:STE 6
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-7311
Practice Address - Country:US
Practice Address - Phone:808-757-9292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI19585207R00000X
WAMD00040641208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA232517OtherLNI
WA232517OtherLNI
WAGAB26553Medicare PIN
WA232517OtherLNI
WA8296279Medicaid
WAGAB26557Medicare PIN
WAG8881684Medicare PIN
WAGAB26555Medicare PIN
WAGAB26556Medicare PIN
WAG8872246Medicare PIN