Provider Demographics
NPI:1881728244
Name:OTSUKA, TAKESHI (LAC LMT)
Entity type:Individual
Prefix:
First Name:TAKESHI
Middle Name:
Last Name:OTSUKA
Suffix:
Gender:M
Credentials:LAC LMT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:775 KINALAU PL
Mailing Address - Street 2:1602
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2656
Mailing Address - Country:US
Mailing Address - Phone:808-566-6787
Mailing Address - Fax:
Practice Address - Street 1:932 WARD AVE
Practice Address - Street 2:#600
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2131
Practice Address - Country:US
Practice Address - Phone:808-535-5555
Practice Address - Fax:808-535-5556
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIACU-657171100000X
HIMAT-6132225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist