Provider Demographics
NPI:1710126743
Name:KITAOKA, SEAN KIA'I (PHD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:KIA'I
Last Name:KITAOKA
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 1:34004 9TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6737
Mailing Address - Country:US
Mailing Address - Phone:808-292-2642
Mailing Address - Fax:
Practice Address - Street 1:5037 S ORCHARD ST APT A
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98467-3671
Practice Address - Country:US
Practice Address - Phone:808-292-2642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-14
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
WAPY-60315205103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist