Provider Demographics
NPI:1871249821
Name:ENDOW, WESLEY KANKO
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:KANKO
Last Name:ENDOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99-018 POOHOLUA DR
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3557
Mailing Address - Country:US
Mailing Address - Phone:916-501-2742
Mailing Address - Fax:
Practice Address - Street 1:1010 PENSACOLA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2118
Practice Address - Country:US
Practice Address - Phone:808-432-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-4909225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist