Provider Demographics
NPI:1043386840
Name:KONA THERAPY ASSOCIATES INC.
Entity Type:Organization
Organization Name:KONA THERAPY ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-961-5500
Mailing Address - Street 1:101 AUPUNI ST.
Mailing Address - Street 2:STE #118
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4260
Mailing Address - Country:US
Mailing Address - Phone:808-961-5500
Mailing Address - Fax:
Practice Address - Street 1:101 AUPUNI ST.
Practice Address - Street 2:STE #118
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4260
Practice Address - Country:US
Practice Address - Phone:808-961-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04937802Medicaid
HI04937803Medicaid
HI04937802Medicaid
HI04937803Medicaid