Provider Demographics
NPI:1003318486
Name:PAAGA, TYSAN (LMT)
Entity type:Individual
Prefix:MR
First Name:TYSAN
Middle Name:
Last Name:PAAGA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-265 WILLIAM HENRY RD APT H5
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3148
Mailing Address - Country:US
Mailing Address - Phone:808-387-2429
Mailing Address - Fax:
Practice Address - Street 1:46-012 KAMEHAMEHA HWY STE B1
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-6701
Practice Address - Country:US
Practice Address - Phone:808-235-2828
Practice Address - Fax:808-235-2828
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI15565225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist