Provider Demographics
NPI:1811963994
Name:SUGIYAMA, GLEN H (MD)
Entity type:Individual
Prefix:
First Name:GLEN
Middle Name:H
Last Name:SUGIYAMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 MILIANI STREET
Mailing Address - Street 2:SUITE 702A
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:808-523-9363
Mailing Address - Fax:808-523-9418
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:SUITE 203
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-538-3021
Practice Address - Fax:808-533-6397
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 4337207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIC011621OtherHMSA
HI01112001Medicaid
HIC011621OtherHMSA
C98937Medicare UPIN