Healthcare Provider Details

I. General information

NPI: 1548182389
Provider Name (Legal Business Name): THAI HEALING MASSAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-3525 KAULUAKOKO ST UNIT 2008
EWA BEACH HI
96706-6874
US

IV. Provider business mailing address

91-053 PARISH DR
EWA BEACH HI
96706-2513
US

V. Phone/Fax

Practice location:
  • Phone: 808-724-9962
  • Fax:
Mailing address:
  • Phone: 808-225-8299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: PHAKHANUN SRINUAN LEE
Title or Position: OWNER
Credential:
Phone: 808-724-9962