Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 85 | HI |
NPI | 1124292636 |
---|---|
Provider Name | Keith Joji Yamamoto |
First Address | Honolulu, HI 96814-1924 |
Second Address | Honolulu, HI 96814-1924 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2008 |
Last Update Date | 15/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
W05195580-04 | GENERAL EXCISE TAX (01) | HI |