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General NPI Number Information
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NPI Number | 1205618113
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Entity Type | Organization
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Legal Business Name | SUPREME WELLNESS
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Dates
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Enumeration Date | 10/16/2023
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 1001 WAIMANU ST # D
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City | HONOLULU
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State | HI
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Zip | 96814-3411
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Country | US
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Telephone | 808-294-2632
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Fax |
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Provider Business Mailing Address
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Address Line | 665 HALEKAUWILA ST APT 2004
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City | HONOLULU
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State | HI
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Zip | 96813-5914
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTITIONER
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Name | SHANNYN MATSUMOTO
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Credential |
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Telephone | 808-294-2632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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