Provider Demographics
NPI:1679237960
Name:DIVERS, YUN CHING SUM (MT)
Entity Type:Individual
Prefix:
First Name:YUN CHING
Middle Name:SUM
Last Name:DIVERS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 COYNE ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1333
Mailing Address - Country:US
Mailing Address - Phone:808-429-5101
Mailing Address - Fax:
Practice Address - Street 1:1600 KAPIOLANI BLVD STE 1340
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3806
Practice Address - Country:US
Practice Address - Phone:808-942-2232
Practice Address - Fax:808-947-1419
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-24
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMA-16290225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist