Provider Demographics
NPI:1750148110
Name:TOMIOKA, KEUM
Entity type:Individual
Prefix:
First Name:KEUM
Middle Name:
Last Name:TOMIOKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 KALAKAUA AVE STE 204C
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-3757
Mailing Address - Country:US
Mailing Address - Phone:808-951-0123
Mailing Address - Fax:
Practice Address - Street 1:1750 KALAKAUA AVE STE 204C
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-3757
Practice Address - Country:US
Practice Address - Phone:808-951-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-11266225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist