Provider Demographics
NPI:1467602086
Name:WADA, NAOMI KINOSHITA (PT)
Entity Type:Individual
Prefix:MRS
First Name:NAOMI
Middle Name:KINOSHITA
Last Name:WADA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2263 AUPAKA ST
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-1215
Mailing Address - Country:US
Mailing Address - Phone:808-456-1294
Mailing Address - Fax:
Practice Address - Street 1:99-128 AIEA HEIGHTS DR
Practice Address - Street 2:SUITE 207
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3925
Practice Address - Country:US
Practice Address - Phone:808-487-0487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-98174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist