Healthcare Provider Details

I. General information

NPI: 1396399473
Provider Name (Legal Business Name): LONGEVITY HEALTH CENTER, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2019
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 MAIN ST
WAILUKU HI
96793-1648
US

IV. Provider business mailing address

2045 MAIN ST
WAILUKU HI
96793-1648
US

V. Phone/Fax

Practice location:
  • Phone: 808-242-8844
  • Fax: 808-244-7414
Mailing address:
  • Phone: 808-242-8844
  • Fax: 808-244-7414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOYCE TAMORI
Title or Position: VICE PRESIDENT
Credential:
Phone: 808-242-8844