Healthcare Provider Details

I. General information

NPI: 1912063595
Provider Name (Legal Business Name): THE TRANSPORT GUY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-1049 HALEAINA ST
WAIPAHU HI
96797-5450
US

IV. Provider business mailing address

PO BOX 971082
WAIPAHU HI
96797-1082
US

V. Phone/Fax

Practice location:
  • Phone: 808-778-2169
  • Fax: 808-688-0610
Mailing address:
  • Phone: 808-778-2169
  • Fax: 808-688-0610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberW19521008-01
License Number StateHI

VIII. Authorized Official

Name: MR. GUY MASAMI TAKAKI
Title or Position: OWNER
Credential: L.P.N.
Phone: 808-778-2169