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General NPI Number Information
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NPI Number | 1528107349
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Entity Type | Individual
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Provider Name | DUSTIN YOSHIO EBESU L.M.T.
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Gender | Male
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 03/24/2010
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Provider Practice Location Address
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Address Line | 3427 WAIALAE AVE STE D
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City | HONOLULU
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State | HI
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Zip | 96816-2630
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Country | US
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Telephone | 808-225-7822
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Fax |
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Provider Business Mailing Address
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Address Line | 98-1231 PAKONANE PL
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City | AIEA
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State | HI
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Zip | 96701-3441
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Country | US
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Telephone | 808-225-7822
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MAT2826
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License Number State | HI
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