Provider Demographics
NPI:1598598328
Name:MASUDA, KIMBERLY KANANI (DPT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KANANI
Last Name:MASUDA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-1043 HEAHEA ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4706
Mailing Address - Country:US
Mailing Address - Phone:808-551-3114
Mailing Address - Fax:
Practice Address - Street 1:458 MANAWAI ST APT 1203
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-4612
Practice Address - Country:US
Practice Address - Phone:808-367-0986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5979225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist