Provider Demographics
NPI:1861969628
Name:MATSUMOTO, KIKUE (MT)
Entity type:Individual
Prefix:
First Name:KIKUE
Middle Name:
Last Name:MATSUMOTO
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 OHUA AVE
Mailing Address - Street 2:T1-606
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815
Mailing Address - Country:US
Mailing Address - Phone:808-636-6443
Mailing Address - Fax:
Practice Address - Street 1:1272 S KING ST STE 203
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1936
Practice Address - Country:US
Practice Address - Phone:808-636-6443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI13629225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist