Provider Demographics
NPI:1346481801
Name:JONES, KYOHO HANAMORI (LMT)
Entity Type:Individual
Prefix:
First Name:KYOHO
Middle Name:HANAMORI
Last Name:JONES
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 1:1504 FARLOW AVE
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1516
Mailing Address - Country:US
Mailing Address - Phone:410-814-1322
Mailing Address - Fax:
Practice Address - Street 1:1504 FARLOW AVE
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1516
Practice Address - Country:US
Practice Address - Phone:410-814-1322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM04102174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist