Provider Demographics
NPI:1942309448
Name:KUNIMURA, SHAUN (PT)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:KUNIMURA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46-005 KAWA ST STE 211
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3838
Mailing Address - Country:US
Mailing Address - Phone:808-235-6818
Mailing Address - Fax:808-200-4584
Practice Address - Street 1:46-005 KAWA ST STE 211
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3838
Practice Address - Country:US
Practice Address - Phone:808-235-6818
Practice Address - Fax:808-200-4584
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI572348Medicaid
HI572348Medicaid