Provider Demographics
NPI:1760610398
Name:YOUNG, MARIE LEILANI KALUHIWA
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:LEILANI KALUHIWA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85-1044 HOOKUIKAHI ST
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-2673
Mailing Address - Country:US
Mailing Address - Phone:808-699-3694
Mailing Address - Fax:
Practice Address - Street 1:85-993 FARRINGTON HWY RM 204
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-2679
Practice Address - Country:US
Practice Address - Phone:808-696-9179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT 11196225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist