Individual
RYAN FUSATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
110 E KAAHUMANU AVE, KAHULUI, HI 96732-2118
(808) 242-6464
(808) 243-2367
Mailing address
2180 MAIN ST, WAILUKU, HI 96793-1666
(808) 242-6464
(808) 984-7434
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD11340
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
152343
UHA
HI
05
—
500018
—
HI
05
—
50001802
—
HI
01
—
99017685996793D002
TRICARE - CHAMPUS
HI
01
—
A0229789
HMSA - 65CP - HMSA QUEST
HI
Enumeration date
07/17/2006
Last updated
03/19/2019
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