Provider Demographics
NPI:1780220897
Name:MIYA, KARI LEILANI
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:LEILANI
Last Name:MIYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HIKARI
Other - Middle Name:LEILANI
Other - Last Name:MIYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1755 OFARRELL ST APT PH1E
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-5298
Mailing Address - Country:US
Mailing Address - Phone:559-212-0422
Mailing Address - Fax:
Practice Address - Street 1:1755 OFARRELL ST APT PH1E
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-5298
Practice Address - Country:US
Practice Address - Phone:559-212-0422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-24
Last Update Date:2019-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician