Provider Demographics
NPI:1891454534
Name:LEE, KIRA YAH FUN (LCSW)
Entity Type:Individual
Prefix:
First Name:KIRA
Middle Name:YAH FUN
Last Name:LEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 KILAUEA AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5235
Mailing Address - Country:US
Mailing Address - Phone:808-352-7227
Mailing Address - Fax:
Practice Address - Street 1:970 N KALAHEO AVE STE A216
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1869
Practice Address - Country:US
Practice Address - Phone:808-387-4355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI47481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical