Provider Demographics
NPI:1275280091
Name:PATRICK K KAMAKAWIWO'OLE, PSYD, LLC
Entity Type:Organization
Organization Name:PATRICK K KAMAKAWIWO'OLE, PSYD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:K
Authorized Official - Last Name:KAMAKAWIWOOLE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-258-6697
Mailing Address - Street 1:1188 BISHOP ST STE 3510
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3314
Mailing Address - Country:US
Mailing Address - Phone:808-258-6697
Mailing Address - Fax:
Practice Address - Street 1:1188 BISHOP ST STE 3510
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3314
Practice Address - Country:US
Practice Address - Phone:808-258-6697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI620171Medicaid