Provider Demographics
NPI:1043497100
Name:KUAMO'O, JAIME NORIKO (PT)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:NORIKO
Last Name:KUAMO'O
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:NORIKO
Other - Last Name:KAWAGUCHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1070 AWAWAMALU ST APT C
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-2615
Mailing Address - Country:US
Mailing Address - Phone:808-729-4419
Mailing Address - Fax:
Practice Address - Street 1:3660 WAIALAE AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-3257
Practice Address - Country:US
Practice Address - Phone:808-732-2500
Practice Address - Fax:808-732-2501
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29396225100000X
HI3015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA050197Medicare PIN