Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 11561 | HI |
NPI | 1003210618 |
---|---|
Provider Name | Kimiko Miyake |
First Address | Mililani, HI 96789-2985 |
Second Address | Mililani, HI 96789-2985 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2014 |
Last Update Date | 10/10/2014 |