Provider Demographics
NPI:1811627284
Name:BAYUDAN, KRISTIN D (LMT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:D
Last Name:BAYUDAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-1375 KOAHEAHE PL APT 99
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-3510
Mailing Address - Country:US
Mailing Address - Phone:808-284-9435
Mailing Address - Fax:
Practice Address - Street 1:970 N KALAHEO AVE STE C315
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1883
Practice Address - Country:US
Practice Address - Phone:808-254-5577
Practice Address - Fax:808-254-5579
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-15713225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist