Provider Demographics
NPI:1457867681
Name:OMO, KAI
Entity Type:Individual
Prefix:
First Name:KAI
Middle Name:
Last Name:OMO
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 1:92-1300 KIKAHA ST APT 82
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-1565
Mailing Address - Country:US
Mailing Address - Phone:808-387-0070
Mailing Address - Fax:
Practice Address - Street 1:94-1221 KA UKA BLVD, UNIT 108
Practice Address - Street 2:#167
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797
Practice Address - Country:US
Practice Address - Phone:808-292-7968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-15-10771106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician