Provider Demographics
NPI:1164005161
Name:HIGASHI, TAI
Entity Type:Individual
Prefix:
First Name:TAI
Middle Name:
Last Name:HIGASHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4151 MOMI ST
Mailing Address - Street 2:
Mailing Address - City:KILAUEA
Mailing Address - State:HI
Mailing Address - Zip Code:96754-5312
Mailing Address - Country:US
Mailing Address - Phone:808-639-5896
Mailing Address - Fax:
Practice Address - Street 1:1895 HALEUKANA ST FL 2
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-9072
Practice Address - Country:US
Practice Address - Phone:808-346-6690
Practice Address - Fax:888-461-0904
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician