Healthcare Provider Details

I. General information

NPI: 1780702308
Provider Name (Legal Business Name): NATHANIEL U D YESAN LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NATHAN U D YESAN LMT

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4268 RICE ST STE J
LIHUE HI
96766-1318
US

IV. Provider business mailing address

PO BOX 1894
LIHUE HI
96766-5894
US

V. Phone/Fax

Practice location:
  • Phone: 808-652-2946
  • Fax: 808-652-2946
Mailing address:
  • Phone: 808-652-2946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6301
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: