Provider Demographics
NPI:1356640981
Name:YOTSUYA, JEAN (LMT)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:
Last Name:YOTSUYA
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 1:129 HOOWAIWAI LOOP APT 2101
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-4122
Mailing Address - Country:US
Mailing Address - Phone:808-692-6419
Mailing Address - Fax:808-442-9015
Practice Address - Street 1:43 W KAMEHAMEHA AVE
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2256
Practice Address - Country:US
Practice Address - Phone:808-269-6419
Practice Address - Fax:808-442-9015
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4036225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist