Provider Demographics
NPI:1336410554
Name:ILAC, CHAYLEN KK (LMT)
Entity Type:Individual
Prefix:
First Name:CHAYLEN
Middle Name:KK
Last Name:ILAC
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-027 HEKAHA ST STE 3
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4919
Mailing Address - Country:US
Mailing Address - Phone:808-282-2650
Mailing Address - Fax:808-488-2221
Practice Address - Street 1:98-027 HEKAHA ST STE 3
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4919
Practice Address - Country:US
Practice Address - Phone:808-282-2650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-11005225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist