Provider Demographics
NPI:1881953800
Name:TRAN, DIANE (MT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 MAUNAKEA ST
Mailing Address - Street 2:SUITE 275
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-5100
Mailing Address - Country:US
Mailing Address - Phone:808-523-1713
Mailing Address - Fax:
Practice Address - Street 1:1120 MAUNAKEA ST
Practice Address - Street 2:SUITE 275
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5100
Practice Address - Country:US
Practice Address - Phone:808-523-1713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT12238225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist