Provider Demographics
NPI:1336604131
Name:KANESHINA, KAMERON T (DPT)
Entity Type:Individual
Prefix:MR
First Name:KAMERON
Middle Name:T
Last Name:KANESHINA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 KOMO MAI DR
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2244
Mailing Address - Country:US
Mailing Address - Phone:808-298-7401
Mailing Address - Fax:
Practice Address - Street 1:1001 KAMOKILA BLVD STE 114
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2095
Practice Address - Country:US
Practice Address - Phone:808-674-0500
Practice Address - Fax:808-674-0511
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist