Provider Demographics
NPI:1780702308
Name:YESAN, NATHANIEL U D (LMT)
Entity type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:U D
Last Name:YESAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:NATHAN
Other - Middle Name:U D
Other - Last Name:YESAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 1894
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-5894
Mailing Address - Country:US
Mailing Address - Phone:808-652-2946
Mailing Address - Fax:
Practice Address - Street 1:4268 RICE ST STE J
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1318
Practice Address - Country:US
Practice Address - Phone:808-652-2946
Practice Address - Fax:808-652-2946
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI6301225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist