Basic Information
| Provider Information | |||||||||
| NPI: | 1649359662 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KASHIWABARA | ||||||||
| FirstName: | DEAN | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2720 LOWREY AVENUE | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968221636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083861716 | ||||||||
| FaxNumber: | 8087391979 | ||||||||
| Practice Location | |||||||||
| Address1: | 98-1079 MOANALUA ROAD | ||||||||
| Address2: | SUITE 610 | ||||||||
| City: | ALEA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967014716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083861716 | ||||||||
| FaxNumber: | 8087391979 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 09/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT1060 | HI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 248643 | 05 | HI | MEDICAID |