Provider Demographics
NPI:1356483341
Name:MISAKA, BRIAN A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:A
Last Name:MISAKA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99-128 AIEA HEIGHTS DR
Mailing Address - Street 2:701
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3925
Mailing Address - Country:US
Mailing Address - Phone:808-488-7177
Mailing Address - Fax:
Practice Address - Street 1:99-128 AIEA HEIGHTS DR
Practice Address - Street 2:701
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3925
Practice Address - Country:US
Practice Address - Phone:808-488-7177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY777103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical