Provider Demographics
NPI:1285419234
Name:KASHIWABARA, KORY
Entity type:Individual
Prefix:
First Name:KORY
Middle Name:
Last Name:KASHIWABARA
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 1:95-1105 AINAMAKUA DR STE 203
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-6313
Mailing Address - Country:US
Mailing Address - Phone:808-381-8947
Mailing Address - Fax:
Practice Address - Street 1:95-1105 AINAMAKUA DR STE 203
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-6313
Practice Address - Country:US
Practice Address - Phone:808-381-8947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist