Provider Demographics
NPI:1083049381
Name:KUROSUMI, GREYDEN (MS)
Entity Type:Individual
Prefix:MR
First Name:GREYDEN
Middle Name:
Last Name:KUROSUMI
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3247 WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1469
Mailing Address - Country:US
Mailing Address - Phone:808-230-4112
Mailing Address - Fax:
Practice Address - Street 1:3247 WOODLAWN DR
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-1469
Practice Address - Country:US
Practice Address - Phone:808-230-4112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HISP - 1315235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist