1689085151 NPI number — KAANOHIOKALA PEA LMT

Table of content: KAANOHIOKALA PEA LMT (NPI 1689085151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689085151 NPI number — KAANOHIOKALA PEA LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEA
Provider First Name:
KAANOHIOKALA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689085151
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16-566 KEAAU PAHOA RD STE 188-201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEAAU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96749-8137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-333-7890
Provider Business Mailing Address Fax Number:
808-443-0799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17-4221 HUINA RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KURTISTOWN
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96760-8213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-333-7890
Provider Business Practice Location Address Fax Number:
808-443-0799
Provider Enumeration Date:
05/18/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MAT-9551 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1689085151 . This is a "MASSAGE THERAPY" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".