Provider Demographics
NPI:1548470586
Name:YOSHIMOTO, DEAN MAKOA (MPT)
Entity type:Individual
Prefix:MR
First Name:DEAN
Middle Name:MAKOA
Last Name:YOSHIMOTO
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 1:600 KAPIOLANI BLVD STE 409
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5141
Mailing Address - Country:US
Mailing Address - Phone:808-525-5300
Mailing Address - Fax:808-525-5301
Practice Address - Street 1:600 KAPIOLANI BLVD STE 409
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5141
Practice Address - Country:US
Practice Address - Phone:808-525-5300
Practice Address - Fax:808-525-5301
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07928702Medicaid