Healthcare Provider Details

I. General information

NPI: 1588724819
Provider Name (Legal Business Name): PAUL KEN MATSUMOTO MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 KAPIOLANI BLVD SUITE 104
HONOLULU HI
96813-5212
US

IV. Provider business mailing address

770 KAPIOLANI BLVD SUITE 104
HONOLULU HI
96813-5212
US

V. Phone/Fax

Practice location:
  • Phone: 808-596-9446
  • Fax: 808-596-9160
Mailing address:
  • Phone: 808-596-9446
  • Fax: 808-596-9160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1772
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: