Provider Demographics
NPI:1366883506
Name:VAUGHN, C JAIN (LMT)
Entity type:Individual
Prefix:MS
First Name:C
Middle Name:JAIN
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76-219A ROYAL POINCIANA DR
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2255
Mailing Address - Country:US
Mailing Address - Phone:808-756-7091
Mailing Address - Fax:
Practice Address - Street 1:75-5929 ALII DR
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1323
Practice Address - Country:US
Practice Address - Phone:808-756-7091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT 11424225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist