Provider Demographics
NPI:1386106797
Name:INO, TAKURO
Entity type:Individual
Prefix:
First Name:TAKURO
Middle Name:
Last Name:INO
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 1:1030 QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4137
Mailing Address - Country:US
Mailing Address - Phone:310-755-1670
Mailing Address - Fax:
Practice Address - Street 1:1450 ALA MOANA BLVD STE 1227
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4610
Practice Address - Country:US
Practice Address - Phone:808-383-3680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAE-3345172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist