Provider Demographics
NPI:1518379551
Name:TOMITA, KEVIN K (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:K
Last Name:TOMITA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 BISHOP ST STE 929
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2810
Mailing Address - Country:US
Mailing Address - Phone:808-391-3514
Mailing Address - Fax:
Practice Address - Street 1:1164 BISHOP ST STE 929
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2810
Practice Address - Country:US
Practice Address - Phone:808-391-3514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-26
Last Update Date:2020-01-08
Deactivation Date:2019-12-02
Deactivation Code:
Reactivation Date:2020-01-08
Provider Licenses
StateLicense IDTaxonomies
HI1766103TC0700X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical