Provider Demographics
NPI:1821742271
Name:IZUMIGAWA, DEVON (LAC)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:IZUMIGAWA
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 AOLOA ST APT B230
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3063
Mailing Address - Country:US
Mailing Address - Phone:808-554-8879
Mailing Address - Fax:
Practice Address - Street 1:370 N KALAHEO AVE STE 116
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:808-270-5001
Practice Address - Fax:808-270-5003
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1286171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty