Provider Demographics
NPI:1306247937
Name:GLENN S. YONEMURA, MD INC
Entity type:Organization
Organization Name:GLENN S. YONEMURA, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:SATORU
Authorized Official - Last Name:YONEMURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-735-3764
Mailing Address - Street 1:3221 WAIALAE AVE STE 382
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5845
Mailing Address - Country:US
Mailing Address - Phone:808-735-3764
Mailing Address - Fax:808-732-9463
Practice Address - Street 1:3221 WAIALAE AVE STE 382
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5845
Practice Address - Country:US
Practice Address - Phone:808-735-3764
Practice Address - Fax:808-732-9463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5308261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0237260-1Medicaid
HI0237260-1Medicaid
H0000BFBRSMedicare PIN