MEDICARE: SERENITY THAI MASSAGE HAWAII LLC

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	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1811850340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY THAI MASSAGE HAWAII LLC

Provider Business Mailing Address
First Line	:	94-794 KAAHOLO ST
Second Line	:
City	:	WAIPAHU
State	:	HI
Zip	:	96797-1284
Country	:	US
Telephone Number	:	808-798-7062
Fax Number	:

Provider Business Practice Location Address
First Line	:	91-3575 IWIKUAMOO ST UNIT 303
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-6895
Country	:	US
Telephone Number	:	808-798-7062
Fax Number	:

Authorized Official
Title or Position	:	MASSAGE THERAPIST
Name	:	MRS. YANISA THONG EMPLEO
Credential	:
Telephone Number	:	929-464-5978

Provider Enumeration Date	:	12/03/2025
Last Update Date	:	12/03/2025

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