Provider Demographics
NPI:1578059473
Name:KINOSHITA, KYLE SHO
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:SHO
Last Name:KINOSHITA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-548 MAHINUI RD
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-1741
Mailing Address - Country:US
Mailing Address - Phone:808-236-9910
Mailing Address - Fax:
Practice Address - Street 1:95-732 MAIAKU ST
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-2816
Practice Address - Country:US
Practice Address - Phone:808-321-8105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician