Provider Demographics
NPI:1285225284
Name:TSURUDA, JENSEN NAMILIMILI HIROSHI (DPT)
Entity Type:Individual
Prefix:
First Name:JENSEN
Middle Name:NAMILIMILI HIROSHI
Last Name:TSURUDA
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 1:1393 ALA AOLANI ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1466
Mailing Address - Country:US
Mailing Address - Phone:808-221-5595
Mailing Address - Fax:
Practice Address - Street 1:5722 KALANIANAOLE HWY
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-2388
Practice Address - Country:US
Practice Address - Phone:808-373-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-5122225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist