Provider Demographics
NPI:1457392029
Name:MIYAKI, CLYDE T (MD)
Entity Type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:T
Last Name:MIYAKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 KAPAHULU AVE
Mailing Address - Street 2:301
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-1332
Mailing Address - Country:US
Mailing Address - Phone:808-733-5111
Mailing Address - Fax:808-733-5122
Practice Address - Street 1:1029 KAPAHULU AVE
Practice Address - Street 2:301
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-1332
Practice Address - Country:US
Practice Address - Phone:808-733-5111
Practice Address - Fax:808-733-5122
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-3994207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI024287-01Medicaid
HI024287-01Medicaid
HIC98857Medicare UPIN