Provider Demographics
NPI:1134367865
Name:MORITA, JOHN TAKAMI
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:TAKAMI
Last Name:MORITA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 AHIHI ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-3773
Mailing Address - Country:US
Mailing Address - Phone:808-845-8003
Mailing Address - Fax:
Practice Address - Street 1:1640 AHIHI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-3773
Practice Address - Country:US
Practice Address - Phone:808-845-8003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI106S00000X106S00000X
171M00000X
HIRBT-21-181024106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator