Provider Demographics
NPI:1811942584
Name:OGINO, KATHLEEN A L (DPT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A L
Last Name:OGINO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92-1448 PALAHIA ST
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-3306
Mailing Address - Country:US
Mailing Address - Phone:808-599-0045
Mailing Address - Fax:808-591-0004
Practice Address - Street 1:1001 KAMOKILA BLVD
Practice Address - Street 2:#114
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2097
Practice Address - Country:US
Practice Address - Phone:808-674-0500
Practice Address - Fax:808-674-0511
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT784225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI567414Medicaid
HI00C0240915OtherTRIWEST
HI525690OtherSUMMERLIN
HI00C0240915OtherHMSA BASIC,65C/65C,HMO
HI204435027OtherHMAA
HI7848787OtherUHA
HI204435027OtherHMAA
HI00C0240915OtherTRIWEST
HI7848787OtherUHA