1831333061 NPI number — MS. CHARIS YOSHIE KEALAKAI KEPOO

Table of content: MS. CHARIS YOSHIE KEALAKAI KEPOO (NPI 1831333061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831333061 NPI number — MS. CHARIS YOSHIE KEALAKAI KEPOO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEPOO
Provider First Name:
CHARIS
Provider Middle Name:
YOSHIE KEALAKAI
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831333061
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1709 NOELANI ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEARL CITY
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96782-2076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-398-3247
Provider Business Mailing Address Fax Number:
808-455-2484

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1709 NOELANI ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEARL CITY
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96782-2076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-398-3247
Provider Business Practice Location Address Fax Number:
808-455-2484
Provider Enumeration Date:
05/01/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171W00000X , with the licence number:  MAT 10666 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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