Provider Demographics
NPI:1396905592
Name:MATSUOKA, LOIS YUKIKO
Entity type:Individual
Prefix:DR
First Name:LOIS
Middle Name:YUKIKO
Last Name:MATSUOKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61940
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814
Mailing Address - Country:US
Mailing Address - Phone:808-941-5506
Mailing Address - Fax:
Practice Address - Street 1:1010 SOUTH KING STREET
Practice Address - Street 2:SUITE 111
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96839
Practice Address - Country:US
Practice Address - Phone:808-941-5506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD3510207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000BDZKLMedicare PIN
C32640Medicare UPIN