Provider Demographics
NPI:1740497577
Name:AGOOT, YUKI M (LMT)
Entity type:Individual
Prefix:MS
First Name:YUKI
Middle Name:M
Last Name:AGOOT
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:PO BOX 901
Mailing Address - Street 2:
Mailing Address - City:CAPTAIN COOK
Mailing Address - State:HI
Mailing Address - Zip Code:96704-0901
Mailing Address - Country:US
Mailing Address - Phone:808-322-8151
Mailing Address - Fax:
Practice Address - Street 1:74-5615 LUHIA ST
Practice Address - Street 2:ICICLES A HAIR SALON SUITE C2
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3622
Practice Address - Country:US
Practice Address - Phone:808-322-8151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT #5267225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist