Provider Demographics
NPI:1205133477
Name:NAKATSU, BRIAN M
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
Last Name:NAKATSU
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 1:94-1040 KIKEPA ST APT B
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-5526
Mailing Address - Country:US
Mailing Address - Phone:808-497-9168
Mailing Address - Fax:
Practice Address - Street 1:1120 MAUNAKEA ST
Practice Address - Street 2:SUITE 275
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5100
Practice Address - Country:US
Practice Address - Phone:808-497-9168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11600225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist