Provider Demographics
NPI:1487755583
Name:YAMAMOTO, KENT SATOSHI (MD)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:SATOSHI
Last Name:YAMAMOTO
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 1:500 ALA MOANA BLVD STE 2-200
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-4993
Mailing Address - Country:US
Mailing Address - Phone:808-628-1652
Mailing Address - Fax:
Practice Address - Street 1:226 N KUAKINI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2421
Practice Address - Country:US
Practice Address - Phone:808-544-3368
Practice Address - Fax:808-535-1572
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI13878208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI58831101Medicaid
HI58831101Medicaid
HII69061Medicare UPIN