Individual
CODY MIYAMOTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1708 GLEN AVE, WAHIAWA, HI 96786-2618
(808) 428-4940
Mailing address
1708 GLEN AVE, WAHIAWA, HI 96786-2618
(808) 428-4940
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MAT-13727
HI
Other
Enumeration date
05/27/2015
Last updated
05/27/2015
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