Healthcare Provider Details

I. General information

NPI: 1386472314
Provider Name (Legal Business Name): KYNASTON KAIKA LINDSEY LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64-1035 MAMALAHOA HWY STE F
KAMUELA HI
96743-8440
US

IV. Provider business mailing address

64-5071 KAMAMALU ST
KAMUELA HI
96743-8457
US

V. Phone/Fax

Practice location:
  • Phone: 808-885-5900
  • Fax:
Mailing address:
  • Phone: 808-345-2505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAT-13154
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: