Provider Demographics
NPI:1215973029
Name:YAMAGUCHI, KAREN C (DPM)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:C
Last Name:YAMAGUCHI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 PIIKOI ST
Mailing Address - Street 2:SUITE 1401
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3116
Mailing Address - Country:US
Mailing Address - Phone:808-591-0020
Mailing Address - Fax:808-591-0080
Practice Address - Street 1:615 PIIKOI ST
Practice Address - Street 2:SUITE 1401
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3116
Practice Address - Country:US
Practice Address - Phone:808-591-0020
Practice Address - Fax:808-591-0080
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1528213ES0131X
HI123213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140993002Medicaid
TX0082FAOtherBC BS PROVIDER NUMBER
TX8K8578Medicare PIN
TX00546PMedicare PIN
TXU83446Medicare UPIN
TX00546PMedicare ID - Type Unspecified
TX0082FAOtherBC BS PROVIDER NUMBER