Provider Demographics
NPI:1477302875
Name:CHUNG, NICOLE ANN PAMPLONA (LMT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN PAMPLONA
Last Name:CHUNG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ANN PAMPLONA
Other - Last Name:TABADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:2327 AMOOMOO ST
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782
Mailing Address - Country:US
Mailing Address - Phone:808-224-7475
Mailing Address - Fax:
Practice Address - Street 1:94-801 FARRINGTON HWY
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3164
Practice Address - Country:US
Practice Address - Phone:808-680-9123
Practice Address - Fax:808-680-9889
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI13459225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist