Provider Demographics
NPI:1588724819
Name:MATSUMOTO, PAUL KEN (MPT)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:KEN
Last Name:MATSUMOTO
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5212
Mailing Address - Country:US
Mailing Address - Phone:808-596-9446
Mailing Address - Fax:808-596-9160
Practice Address - Street 1:770 KAPIOLANI BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5212
Practice Address - Country:US
Practice Address - Phone:808-596-9446
Practice Address - Fax:808-596-9160
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI17722251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI20-0684033OtherHMAA NUMBER
HI201834OtherHMA NUMBER
HIZ1654OtherQUEENS HEALTH CARE PLAN
HIC0223549OtherHMSA NUMBER
HI3740566OtherUHA NUMBER
HI00C0223549OtherHMSA QUEST NUMBER
HI24883001Medicaid
HI200684033OtherUHC NUMBER
HI201834OtherSUMMERLIN NUMBER
HI209006700OtherOWCP NUMBER
HI24883003OtherALOHA CARE NUMBER
HIZ1654OtherQUEENS HEALTH CARE PLAN