MEDICARE: YUN CHING SUM DIVERS MT

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	MA-16290	HI

General Provider Information

NPI Number	:	1679237960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YUN CHING SUM DIVERS MT

Provider Business Mailing Address
First Line	:	2022 COYNE ST
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96826-1333
Country	:	US
Telephone Number	:	808-429-5101
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 KAPIOLANI BLVD STE 1340
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96814-3806
Country	:	US
Telephone Number	:	808-942-2232
Fax Number	:	808-947-1419

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

Provider Enumeration Date	:	10/24/2021
Last Update Date	:	10/24/2021

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Directions to “ YUN CHING SUM DIVERS MT” Practice Location

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