Provider Demographics
NPI:1992948871
Name:IMOTO, YOUHEI
Entity type:Individual
Prefix:
First Name:YOUHEI
Middle Name:
Last Name:IMOTO
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 89097
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96830-7097
Mailing Address - Country:US
Mailing Address - Phone:808-304-6676
Mailing Address - Fax:808-800-2654
Practice Address - Street 1:120 KAIULANI AVE
Practice Address - Street 2:# 10&11
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-6203
Practice Address - Country:US
Practice Address - Phone:917-754-5297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3948225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist