Provider Demographics
NPI:1760426944
Name:MITSUDA, CHASE KEN (ATC)
Entity Type:Individual
Prefix:MR
First Name:CHASE
Middle Name:KEN
Last Name:MITSUDA
Suffix:
Gender:M
Credentials:ATC
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Mailing Address - Street 1:45-697 KAMEHAMEHA HWY
Mailing Address - Street 2:APT # 207
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2053
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2445 KAALA STREET
Practice Address - Street 2:MID PACIFIC INSTITUTE
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-2299
Practice Address - Country:US
Practice Address - Phone:808-973-5091
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer