Provider Demographics
NPI:1033287313
Name:COONEY, JON (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:
Last Name:COONEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 KAPAHULU AVE
Mailing Address - Street 2:STE 310
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-1332
Mailing Address - Country:US
Mailing Address - Phone:808-486-3600
Mailing Address - Fax:808-733-5122
Practice Address - Street 1:1029 KAPAHULU AVE
Practice Address - Street 2:STE 310
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-1332
Practice Address - Country:US
Practice Address - Phone:808-486-3600
Practice Address - Fax:808-733-5122
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI91182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI086954-04Medicaid
100171Medicare ID - Type Unspecified
HI086954-04Medicaid