Basic Information
| Provider Information | |||||||||
| NPI: | 1982272225 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAWAMURA | ||||||||
| FirstName: | SHAYNA | ||||||||
| MiddleName: | MAKIKO WEN FENG | ||||||||
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| Mailing Information | |||||||||
| Address1: | 970 PROSPECT ST | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968223418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084600224 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4510 SALT LAKE BLVD STE D8 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968183172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084861804 | ||||||||
| FaxNumber: | 8084869199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2021 | ||||||||
| LastUpdateDate: | 06/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
No ID Information.