=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255144291
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TYLER KIMURA AGENCY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2025
-----------------------------------------------------
Last Update Date | 01/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 DILLINGHAM BLVD STE 317
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96817-4551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-207-8558
-----------------------------------------------------
Fax | 808-207-8557
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 99-619 HOOHALAWAI PL
-----------------------------------------------------
City | AIEA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96701-3647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-221-8425
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | TYLER TAKAMI KIMURA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 808-207-8558
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------