Provider Demographics
NPI:1881905388
Name:AMANO, MASAHISA (MD)
Entity type:Individual
Prefix:
First Name:MASAHISA
Middle Name:
Last Name:AMANO
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 1:66-125 KAMEHAMEHA HWY
Mailing Address - Street 2:HALEIWA FAMILY HEALTH CENTER
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-1601
Mailing Address - Country:US
Mailing Address - Phone:808-637-5087
Mailing Address - Fax:
Practice Address - Street 1:66-125 KAMEHAMEHA HWY
Practice Address - Street 2:HALEIWA FAMILY HEALTH CENTER
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-1601
Practice Address - Country:US
Practice Address - Phone:808-637-5087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI17088207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine