Provider Demographics
NPI:1265157275
Name:FUKUDA, KAUIONALANI LEAH CHIEKO (PSYD)
Entity type:Individual
Prefix:
First Name:KAUIONALANI
Middle Name:LEAH CHIEKO
Last Name:FUKUDA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 LEILANI ST APT A
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4454
Mailing Address - Country:US
Mailing Address - Phone:808-443-1910
Mailing Address - Fax:
Practice Address - Street 1:16-179 MELEKAHIWA ST
Practice Address - Street 2:
Practice Address - City:KEAAU
Practice Address - State:HI
Practice Address - Zip Code:96749-8026
Practice Address - Country:US
Practice Address - Phone:808-969-9994
Practice Address - Fax:808-982-5272
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist