Provider Demographics
NPI:1093556888
Name:TAKIGUCHI, JARED YASUO
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:YASUO
Last Name:TAKIGUCHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-326 POIKI ST
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-1884
Mailing Address - Country:US
Mailing Address - Phone:808-347-7071
Mailing Address - Fax:
Practice Address - Street 1:91-1121 KEAUNUI DR STE 203
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-6366
Practice Address - Country:US
Practice Address - Phone:808-689-9994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist