Provider Demographics
NPI:1790291011
Name:KUKAHIWA-HARUNO, MICHAEL KAWAILOHIA MITSUO JR (MS, RBT-15-07111)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:KAWAILOHIA MITSUO
Last Name:KUKAHIWA-HARUNO
Suffix:JR
Gender:M
Credentials:MS, RBT-15-07111
Other - Prefix:
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Mailing Address - Street 1:91-1081 IWIKUAMOO ST APT 1105
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-5810
Mailing Address - Country:US
Mailing Address - Phone:808-782-5456
Mailing Address - Fax:
Practice Address - Street 1:550 KUNEHI ST APT 205
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2069
Practice Address - Country:US
Practice Address - Phone:808-780-0014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIRBT-15-07111106S00000X
HIMHC-726101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician