Provider Demographics
NPI:1548482623
Name:NISHIYAMA, JUNEDALE YUKA (MD)
Entity type:Individual
Prefix:DR
First Name:JUNEDALE
Middle Name:YUKA
Last Name:NISHIYAMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:TRIPLER ARMY MEDICAL CENTER 1 JARRETT WHITE RD
Mailing Address - Street 2:
Mailing Address - City:TRIPLER AMC
Mailing Address - State:HI
Mailing Address - Zip Code:96859-5001
Mailing Address - Country:US
Mailing Address - Phone:808-433-5420
Mailing Address - Fax:
Practice Address - Street 1:WARRIOR OHANA MEDICAL HOME 91-1010 SHANGRILA ST
Practice Address - Street 2:STE 500
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2176
Practice Address - Country:US
Practice Address - Phone:808-433-5420
Practice Address - Fax:808-682-4001
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA95075207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMD 15473OtherSTATE MEDICAL LICENSE
NMMD2007-0259OtherSTATE MEDICAL LICENSE
CAA95075OtherSTATE MEDICAL LICENSE
HIHCW9842Medicare UPIN