Healthcare Provider Details

I. General information

NPI: 1306236989
Provider Name (Legal Business Name): KOHHEI OHNISHI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1634 CLARK ST APT A
HONOLULU HI
96822-4808
US

IV. Provider business mailing address

1634 CLARK ST APT A
HONOLULU HI
96822-4808
US

V. Phone/Fax

Practice location:
  • Phone: 205-239-2838
  • Fax:
Mailing address:
  • Phone: 205-239-2838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-49
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: