Provider Demographics
NPI:1821041484
Name:KIYOTA, HEIDE P (PHD)
Entity Type:Individual
Prefix:
First Name:HEIDE
Middle Name:P
Last Name:KIYOTA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319A N CANE ST
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-2109
Mailing Address - Country:US
Mailing Address - Phone:808-621-1820
Mailing Address - Fax:808-621-0540
Practice Address - Street 1:319A N CANE ST
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-2109
Practice Address - Country:US
Practice Address - Phone:808-621-1820
Practice Address - Fax:808-621-0540
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 349103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI024298-02Medicaid
HI024298-02Medicaid