Provider Demographics
NPI:1821577461
Name:ASATO, DEREK E (LAC)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:E
Last Name:ASATO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-1042 KA UKA BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-6209
Mailing Address - Country:US
Mailing Address - Phone:808-888-4409
Mailing Address - Fax:
Practice Address - Street 1:94-1042 KA UKA BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-6209
Practice Address - Country:US
Practice Address - Phone:808-888-4409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2020-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU-1240171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI82-3985665Medicaid