Provider Demographics
NPI:1083996144
Name:UNLU, SESAME (LAC, LMT)
Entity Type:Individual
Prefix:
First Name:SESAME
Middle Name:
Last Name:UNLU
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 KOKOMO RD
Mailing Address - Street 2:
Mailing Address - City:HAIKU
Mailing Address - State:HI
Mailing Address - Zip Code:96708-5027
Mailing Address - Country:US
Mailing Address - Phone:808-283-5046
Mailing Address - Fax:
Practice Address - Street 1:3681 BALDWIN AVE
Practice Address - Street 2:G-103
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-7505
Practice Address - Country:US
Practice Address - Phone:808-283-5046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI982171100000X
HIMAT - 7355225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist