Provider Demographics
NPI:1154461317
Name:TAN, HAZUKI T (LMT)
Entity Type:Individual
Prefix:MS
First Name:HAZUKI
Middle Name:T
Last Name:TAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1013 KAIKAUHAA ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-5060
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:94-615 KUPUOHI ST
Practice Address - Street 2:SUITE 212
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1124
Practice Address - Country:US
Practice Address - Phone:808-688-1808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT#7967225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1055205OtherAMERICAN SPECIALTY HEALTH