Provider Demographics
NPI:1144743642
Name:KONZO, HIROYOSHI (ATC)
Entity Type:Individual
Prefix:
First Name:HIROYOSHI
Middle Name:
Last Name:KONZO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:796 ISENBERG ST APT 12C
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-2925
Mailing Address - Country:US
Mailing Address - Phone:206-734-2980
Mailing Address - Fax:
Practice Address - Street 1:1337 LOWER CAMPUS RD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-2352
Practice Address - Country:US
Practice Address - Phone:808-956-7144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20000298032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer