Provider Demographics
NPI:1518443639
Name:HASEGAWA, SEAN (LMT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:HASEGAWA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-830 LANIKUAKAA ST
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-2752
Mailing Address - Country:US
Mailing Address - Phone:808-206-5662
Mailing Address - Fax:
Practice Address - Street 1:98-1005 MOANALUA RD SPC 410
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4702
Practice Address - Country:US
Practice Address - Phone:808-488-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI15523225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist