Healthcare Provider Details

I. General information

NPI: 1831743996
Provider Name (Legal Business Name): KRISTEN E.W. SHIMABUKURO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2019
Last Update Date: 07/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S BERETANIA ST STE 550
HONOLULU HI
96814-1880
US

IV. Provider business mailing address

1401 S BERETANIA ST STE 550
HONOLULU HI
96814-1880
US

V. Phone/Fax

Practice location:
  • Phone: 808-381-8947
  • Fax: 808-591-2245
Mailing address:
  • Phone: 808-381-8947
  • Fax: 808-591-2245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberT190605003
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: