Provider Demographics
NPI:1558733881
Name:SHOJI, KYLE
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:SHOJI
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 1:5070 LIKINI ST APT 809
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-2373
Mailing Address - Country:US
Mailing Address - Phone:808-927-0721
Mailing Address - Fax:
Practice Address - Street 1:5070 LIKINI ST
Practice Address - Street 2:APT 809
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-2373
Practice Address - Country:US
Practice Address - Phone:808-927-0721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1295225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist