Provider Demographics
NPI:1982895702
Name:BLAKE YOSHIDA MD, LLC
Entity Type:Organization
Organization Name:BLAKE YOSHIDA MD, LLC
Other - Org Name:BLAKE YOSHIDA, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:HARRISON
Authorized Official - Last Name:YOSHIDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-347-1381
Mailing Address - Street 1:PO BOX 23177
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96823-3177
Mailing Address - Country:US
Mailing Address - Phone:808-347-1381
Mailing Address - Fax:
Practice Address - Street 1:2482 KOMO MAI PL
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-1066
Practice Address - Country:US
Practice Address - Phone:808-347-1381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI14147207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty