Provider Demographics
NPI:1144356783
Name:MATSUYAMA, ROY M (MD)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:M
Last Name:MATSUYAMA
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 1:173 HOOHANA ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2482
Mailing Address - Country:US
Mailing Address - Phone:808-871-7222
Mailing Address - Fax:808-871-2222
Practice Address - Street 1:173 HOOHANA ST
Practice Address - Street 2:SUITE 104
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2482
Practice Address - Country:US
Practice Address - Phone:808-871-7222
Practice Address - Fax:808-871-2222
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI17851207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G584200Medicare PIN
CAZZZ29516ZOtherMEDICARE ID - LINCOLN
CAZZZ43589ZOtherMEDICARE SUBMITTER ID
CAE75082Medicare UPIN
CAZZZ13841ZOtherMEDICARE ID - ROSEVILLE
CAG58420OtherCA MED LICENSE
CAZZZ13842ZOtherMEDICARE ID - CARMICHAEL