Provider Demographics
NPI:1639621402
Name:GATES, KALANI
Entity Type:Individual
Prefix:
First Name:KALANI
Middle Name:
Last Name:GATES
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 1:915 BIRCH ST
Mailing Address - Street 2:APT. 305
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814
Mailing Address - Country:US
Mailing Address - Phone:808-383-3723
Mailing Address - Fax:
Practice Address - Street 1:915 BIRCH ST
Practice Address - Street 2:APT. 305
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2353
Practice Address - Country:US
Practice Address - Phone:808-383-3723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician