Healthcare Provider Details

I. General information

NPI: 1285225284
Provider Name (Legal Business Name): JENSEN NAMILIMILI HIROSHI TSURUDA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5722 KALANIANAOLE HWY
HONOLULU HI
96821-2388
US

IV. Provider business mailing address

1393 ALA AOLANI ST
HONOLULU HI
96819-1466
US

V. Phone/Fax

Practice location:
  • Phone: 808-373-3555
  • Fax:
Mailing address:
  • Phone: 808-221-5595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-5122
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: