Provider Demographics
NPI:1306986922
Name:YAMADA, THELMA M (MD)
Entity type:Individual
Prefix:DR
First Name:THELMA
Middle Name:M
Last Name:YAMADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:THELMA
Other - Middle Name:M
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1885 MAIN ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1828
Mailing Address - Country:US
Mailing Address - Phone:808-242-8526
Mailing Address - Fax:
Practice Address - Street 1:1885 MAIN ST
Practice Address - Street 2:SUITE 405
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1828
Practice Address - Country:US
Practice Address - Phone:808-242-8526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD5272174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist