Provider Demographics
NPI:1912955253
Name:MATSUMOTO, STEWART Y (MD,FACC)
Entity type:Individual
Prefix:DR
First Name:STEWART
Middle Name:Y
Last Name:MATSUMOTO
Suffix:
Gender:M
Credentials:MD,FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 YOUNG ST
Mailing Address - Street 2:SUITE 325
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1609
Mailing Address - Country:US
Mailing Address - Phone:808-621-6459
Mailing Address - Fax:
Practice Address - Street 1:1060 YOUNG ST
Practice Address - Street 2:SUITE 325
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1609
Practice Address - Country:US
Practice Address - Phone:808-621-6459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3058207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIX4130-6OtherHMSA
HI037531-01Medicaid
HIX4130-6OtherHMSA
HIH0000BDFFQMedicare ID - Type Unspecified