Provider Demographics
NPI:1528106671
Name:MATSUDA, STELLA SANAE (MD)
Entity type:Individual
Prefix:DR
First Name:STELLA
Middle Name:SANAE
Last Name:MATSUDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 N KUAKINI ST
Mailing Address - Street 2:SUITE 703
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-6300
Mailing Address - Country:US
Mailing Address - Phone:808-949-1330
Mailing Address - Fax:808-941-3112
Practice Address - Street 1:405 N KUAKINI ST
Practice Address - Street 2:SUITE 703
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-6300
Practice Address - Country:US
Practice Address - Phone:808-949-1330
Practice Address - Fax:808-941-3112
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-4381207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HID36190Medicare UPIN
HIH52315Medicare ID - Type Unspecified