MEDICARE: MR. DUSTIN YOSHIO EBESU L.M.T.

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	225700000X	Massage Therapist	MAT2826	HI

General Provider Information

NPI Number	:	1528107349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DUSTIN YOSHIO EBESU L.M.T.

Provider Business Mailing Address
First Line	:	98-1231 PAKONANE PL
Second Line	:
City	:	AIEA
State	:	HI
Zip	:	96701-3441
Country	:	US
Telephone Number	:	808-225-7822
Fax Number	:

Provider Business Practice Location Address
First Line	:	3427 WAIALAE AVE STE D
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96816-2630
Country	:	US
Telephone Number	:	808-225-7822
Fax Number	:

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	03/24/2010

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