Provider Demographics
NPI:1578698577
Name:KAHEKA REHAB CLINIC, INC.
Entity Type:Organization
Organization Name:KAHEKA REHAB CLINIC, INC.
Other - Org Name:VICTOR M. YAMAMOTO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:MITSUO
Authorized Official - Last Name:YAMAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:808-955-9000
Mailing Address - Street 1:1481 S KING ST
Mailing Address - Street 2:STE 327
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2604
Mailing Address - Country:US
Mailing Address - Phone:808-955-9000
Mailing Address - Fax:808-955-9002
Practice Address - Street 1:1481 S KING ST
Practice Address - Street 2:STE 327
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2506
Practice Address - Country:US
Practice Address - Phone:808-955-9000
Practice Address - Fax:808-955-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1255470829OtherPHYSICAL THERAPIST