Provider Demographics
NPI:1780721290
Name:MIKI, NOBUYUKI (MD)
Entity type:Individual
Prefix:
First Name:NOBUYUKI
Middle Name:
Last Name:MIKI
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 1:405 N KUAKINI ST
Mailing Address - Street 2:STE 1004
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-6301
Mailing Address - Country:US
Mailing Address - Phone:808-521-5220
Mailing Address - Fax:808-536-0320
Practice Address - Street 1:405 N KUAKINI ST STE 1004
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-6301
Practice Address - Country:US
Practice Address - Phone:808-521-5220
Practice Address - Fax:808-441-5588
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD7592207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
990351287OtherFEDERAL TAX ID NUMBER
990351287OtherFEDERAL TAX ID NUMBER
F78024Medicare UPIN