Provider Demographics
NPI:1255517652
Name:GINA LEONG SAMALA, PSY.D, INC.
Entity type:Organization
Organization Name:GINA LEONG SAMALA, PSY.D, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:LEONG
Authorized Official - Last Name:SAMALA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-625-7448
Mailing Address - Street 1:85-979 FARRINGTON HWY STE C
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-2678
Mailing Address - Country:US
Mailing Address - Phone:808-625-7448
Mailing Address - Fax:808-625-7448
Practice Address - Street 1:95-1249 MEHEULA PKWY
Practice Address - Street 2:SUITE B30 UNIT 195
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-1779
Practice Address - Country:US
Practice Address - Phone:808-625-7448
Practice Address - Fax:808-625-7448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-756103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI56756301Medicaid
HIH56631OtherMEDICARE INDIVIDUAL PIN
HIH56629Medicare PIN