Provider Demographics
NPI:1073088183
Name:SOULVONGS, KARANNA (LMT)
Entity Type:Individual
Prefix:MISS
First Name:KARANNA
Middle Name:
Last Name:SOULVONGS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:SOURYCHACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 11636
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96828
Mailing Address - Country:US
Mailing Address - Phone:808-384-9003
Mailing Address - Fax:
Practice Address - Street 1:1136 BISHOP ST. 9TH FLOOR UNION PLAZA
Practice Address - Street 2:SUITE PH1B
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:520-775-2027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23504225700000X
HI9338225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist