Provider Demographics
NPI:1457724387
Name:THAI-ISSAN THERAPEUTIC MASSAGE, LLC
Entity Type:Organization
Organization Name:THAI-ISSAN THERAPEUTIC MASSAGE, LLC
Other - Org Name:THAI-ISSAN MASSAGE ACADEMY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SATHIPORN
Authorized Official - Middle Name:
Authorized Official - Last Name:SONGSORN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, PMT, PDSO
Authorized Official - Phone:808-593-8866
Mailing Address - Street 1:1281 S KING ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2254
Mailing Address - Country:US
Mailing Address - Phone:808-593-8866
Mailing Address - Fax:808-593-8035
Practice Address - Street 1:655 KEEAUMOKU ST STE 102
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3006
Practice Address - Country:US
Practice Address - Phone:808-593-8866
Practice Address - Fax:808-593-8035
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THAI-ISSAN THERAPEUTIC MASSAGE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-30
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-8376225700000X
HIMAT-13238225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty