Provider Demographics
NPI:1154616779
Name:UECHI, MATTHEW
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:UECHI
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 1:347 N KUAKINI ST
Mailing Address - Street 2:HPM-9
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2336
Mailing Address - Country:US
Mailing Address - Phone:808-523-8461
Mailing Address - Fax:808-528-1897
Practice Address - Street 1:347 N KUAKINI ST
Practice Address - Street 2:HPM-9
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2336
Practice Address - Country:US
Practice Address - Phone:808-523-8461
Practice Address - Fax:808-528-1897
Is Sole Proprietor?:No
Enumeration Date:2011-06-11
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
HI17434207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program