Provider Demographics
NPI:1689085151
Name:PEA, KAANOHIOKALA (LMT)
Entity Type:Individual
Prefix:
First Name:KAANOHIOKALA
Middle Name:
Last Name:PEA
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 1:16-566 KEAAU PAHOA RD STE 188-201
Mailing Address - Street 2:
Mailing Address - City:KEAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96749-8137
Mailing Address - Country:US
Mailing Address - Phone:808-333-7890
Mailing Address - Fax:808-443-0799
Practice Address - Street 1:17-4221 HUINA RD.
Practice Address - Street 2:
Practice Address - City:KURTISTOWN
Practice Address - State:HI
Practice Address - Zip Code:96760-8213
Practice Address - Country:US
Practice Address - Phone:808-333-7890
Practice Address - Fax:808-443-0799
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-18
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-9551174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1689085151OtherMASSAGE THERAPY