Provider Demographics
NPI:1376908335
Name:SONGSORN, SATHIPORN (LMT, PMT, PDSO)
Entity type:Individual
Prefix:
First Name:SATHIPORN
Middle Name:
Last Name:SONGSORN
Suffix:
Gender:F
Credentials:LMT, PMT, PDSO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92-1498 ALIINUI DR APT 4
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-4298
Mailing Address - Country:US
Mailing Address - Phone:808-979-6553
Mailing Address - Fax:808-492-1133
Practice Address - Street 1:92-1220 ALIINUI DR
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-4296
Practice Address - Country:US
Practice Address - Phone:808-979-6553
Practice Address - Fax:808-492-1133
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-17
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-8376225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty