Healthcare Provider Details

I. General information

NPI: 1134621378
Provider Name (Legal Business Name): KIMBERLY SUE KAYUHA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY SUE KAYUHA LMT

II. Dates (important events)

Enumeration Date: 03/04/2018
Last Update Date: 12/11/2025
Certification Date:
Deactivation Date: 04/23/2018
Reactivation Date: 12/11/2025

III. Provider practice location address

8775 16TH AVE # 2F
BROOKLYN NY
11214-5801
US

IV. Provider business mailing address

8775 16TH AVE
BROOKLYN NY
11214-5801
US

V. Phone/Fax

Practice location:
  • Phone: 347-424-2106
  • Fax:
Mailing address:
  • Phone: 347-424-2106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number027926
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: