Provider Demographics
NPI:1356639371
Name:GOLD, MARIYA KAI (LAC)
Entity Type:Individual
Prefix:
First Name:MARIYA
Middle Name:KAI
Last Name:GOLD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2419 FERDINAND AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1910
Mailing Address - Country:US
Mailing Address - Phone:808-220-9297
Mailing Address - Fax:808-261-7770
Practice Address - Street 1:320 ULUNIU ST
Practice Address - Street 2:STE #2
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2529
Practice Address - Country:US
Practice Address - Phone:808-262-4550
Practice Address - Fax:808-261-7770
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU 983171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist