Active NPI
Tiffany K Wakumoto, D.P.T.
- Physical Therapist
- Lihue, HI
National Provider Identifier
1316449358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT-4520
- Practice address
- 3088 Aukele Street
Lihue, HI 96766 - Phone
- (808) 632-0033
- Fax
- (808) 632-0077
- NPI assigned
- Mar 6, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | PT-4520 | HI | |
| Physical Therapist | 225100000X | PT-4520 | HI | Primary |
Addresses
Primary practice location
3088 Aukele Street
Lihue, HI 96766
Mailing address
P.O. Box 288
Lihue, HI 96766
Phone (808) 632-0033
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 83776 | Medicaid | HI |
Other names 1
- Ms. Tiffany K Ikeda-Simao
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in HI
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT-4520 | HI | MD | Physical Medicine & Rehabilitation Physician |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Lihue, HI
- NPI 1689651002
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1520294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651536000000",
"number": "1316449358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 288",
"city": "LIHUE",
"state": "HI",
"postal_code": "96766",
"telephone_number": "808-632-0033",
"fax_number": "808-632-0077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3088 AUKELE STREET",
"city": "LIHUE",
"state": "HI",
"postal_code": "96766",
"telephone_number": "808-632-0033",
"fax_number": "808-632-0077"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAKUMOTO",
"first_name": "TIFFANY",
"middle_name": "K",
"name_prefix": "Mrs.",
"credential": "D.P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-03-06",
"last_updated": "2022-05-03",
"certification_date": "2022-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "HI",
"license": "PT-4520",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "HI",
"license": "PT-4520",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "83776",
"state": "HI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "TIFFANY",
"last_name": "IKEDA-SIMAO",
"middle_name": "K",
"prefix": "MS.",
"credential": "D.P.T.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Lihue, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.