Provider Demographics
NPI:1124292636
Name:YAMAMOTO, KEITH JOJI
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:JOJI
Last Name:YAMAMOTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 PIIKOI ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1924
Mailing Address - Country:US
Mailing Address - Phone:808-591-8540
Mailing Address - Fax:808-591-8541
Practice Address - Street 1:1020 PIIKOI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1924
Practice Address - Country:US
Practice Address - Phone:808-591-8540
Practice Address - Fax:808-591-8541
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI85156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIW05195580-04OtherGENERAL EXCISE TAX