Provider Demographics
NPI:1255833612
Name:WAKUMOTO, KAYLEN TOSHIO (DPT)
Entity Type:Individual
Prefix:MR
First Name:KAYLEN
Middle Name:TOSHIO
Last Name:WAKUMOTO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 288
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766
Mailing Address - Country:US
Mailing Address - Phone:808-632-0033
Mailing Address - Fax:808-632-0077
Practice Address - Street 1:3088 AUKELE STREET
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766
Practice Address - Country:US
Practice Address - Phone:808-632-0033
Practice Address - Fax:808-632-0077
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-4313208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation