Provider Demographics
NPI:1457087314
Name:LOW, IKAIKAOKALANI (CMT, MMP)
Entity Type:Individual
Prefix:
First Name:IKAIKAOKALANI
Middle Name:
Last Name:LOW
Suffix:
Gender:M
Credentials:CMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 N MOUNTAIN AVE # 310
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-2114
Mailing Address - Country:US
Mailing Address - Phone:808-783-9862
Mailing Address - Fax:
Practice Address - Street 1:222 N MOUNTAIN AVE STE 212
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5714
Practice Address - Country:US
Practice Address - Phone:909-313-0736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76504225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist