Provider Demographics
NPI:1417614934
Name:SEGAWA, KIAI
Entity Type:Individual
Prefix:
First Name:KIAI
Middle Name:
Last Name:SEGAWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66-449 PAALAA RD APT A
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-1624
Mailing Address - Country:US
Mailing Address - Phone:808-445-7714
Mailing Address - Fax:
Practice Address - Street 1:66-449 PAALAA RD APT A
Practice Address - Street 2:
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-1624
Practice Address - Country:US
Practice Address - Phone:808-445-7714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty