Provider Demographics
NPI:1760412175
Name:COMBS, BRIAN B (PH D)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:B
Last Name:COMBS
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 BISHOP ST
Mailing Address - Street 2:SUITE 3007
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3312
Mailing Address - Country:US
Mailing Address - Phone:808-599-1636
Mailing Address - Fax:808-599-8612
Practice Address - Street 1:226 N KUAKINI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2421
Practice Address - Country:US
Practice Address - Phone:808-544-3366
Practice Address - Fax:808-566-3859
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY485103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00E0005941OtherHAWAII MEDICAL SVC ASSN
HI00636802Medicaid
HI00636802Medicaid
HI0000TCBSFMedicare ID - Type Unspecified