Provider Demographics
NPI:1104525013
Name:WOOD, KYLER HASS
Entity type:Individual
Prefix:MR
First Name:KYLER
Middle Name:HASS
Last Name:WOOD
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:PO BOX 1191
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1191
Mailing Address - Country:US
Mailing Address - Phone:808-321-0549
Mailing Address - Fax:
Practice Address - Street 1:407 ULUNIU ST STE 311
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2544
Practice Address - Country:US
Practice Address - Phone:808-261-4040
Practice Address - Fax:808-261-4040
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI16888225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist