Provider Demographics
NPI:1699860239
Name:TOGO, KOICHIRO (MPH, LPT)
Entity Type:Individual
Prefix:
First Name:KOICHIRO
Middle Name:
Last Name:TOGO
Suffix:
Gender:M
Credentials:MPH, LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 S. KING ST.
Mailing Address - Street 2:SUITE 507
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1952
Mailing Address - Country:US
Mailing Address - Phone:808-591-9310
Mailing Address - Fax:808-597-8873
Practice Address - Street 1:1150 S. KING ST.
Practice Address - Street 2:SUITE 507
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1952
Practice Address - Country:US
Practice Address - Phone:808-591-9310
Practice Address - Fax:808-597-8873
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI868225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist