Provider Demographics
NPI:1083347736
Name:KUBO, KATELYNN HALEKULANI KAYO (RDN, LD)
Entity Type:Individual
Prefix:
First Name:KATELYNN
Middle Name:HALEKULANI KAYO
Last Name:KUBO
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:HAKALAU
Mailing Address - State:HI
Mailing Address - Zip Code:96710-0327
Mailing Address - Country:US
Mailing Address - Phone:808-896-9957
Mailing Address - Fax:
Practice Address - Street 1:82 PUUHONU PL STE 209
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2010
Practice Address - Country:US
Practice Address - Phone:808-796-3125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI311-LD133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered