Provider Demographics
NPI:1073006821
Name:MORAN, KEVIN CHARLES (MS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:CHARLES
Last Name:MORAN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:CHARLES
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:91-3575 KAMOLEHONUA ST UNIT 806
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6882
Mailing Address - Country:US
Mailing Address - Phone:419-680-0551
Mailing Address - Fax:
Practice Address - Street 1:91-3575 KAMOLEHONUA ST UNIT 806
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-6882
Practice Address - Country:US
Practice Address - Phone:419-680-0551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator