Provider Demographics
NPI:1871147413
Name:TONG-ISHIKAWA, KESA
Entity type:Individual
Prefix:
First Name:KESA
Middle Name:
Last Name:TONG-ISHIKAWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47-714 HUI KELU ST APT 4
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-4555
Mailing Address - Country:US
Mailing Address - Phone:808-266-2468
Mailing Address - Fax:
Practice Address - Street 1:407 ULUNIU ST STE 204
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2536
Practice Address - Country:US
Practice Address - Phone:808-266-2468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-9419225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist