MEDICARE: ELENA Y KOZMIDI LAC., LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	1272	HI
2	225700000X	Massage Therapist	10238	HI

General Provider Information

NPI Number	:	1225435076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELENA Y KOZMIDI LAC., LMT

Provider Business Mailing Address
First Line	:	PO BOX 383882
Second Line	:
City	:	WAIKOLOA
State	:	HI
Zip	:	96738-3882
Country	:	US
Telephone Number	:	808-886-0600
Fax Number	:

Provider Business Practice Location Address
First Line	:	64-957 MAMAMLAHOA HWY
Second Line	:	SUITE 403
City	:	WAIMEA
State	:	HI
Zip	:	96738-5810
Country	:	US
Telephone Number	:	808-769-2263
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2014
Last Update Date	:	06/12/2020

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