Provider Demographics
NPI:1356895486
Name:KOAN HEALTH
Entity type:Organization
Organization Name:KOAN HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WATANABE
Authorized Official - Suffix:
Authorized Official - Credentials:CCM, MFT
Authorized Official - Phone:808-469-4505
Mailing Address - Street 1:1580 MAKALOA ST
Mailing Address - Street 2:SUITE 550
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3237
Mailing Address - Country:US
Mailing Address - Phone:808-469-4505
Mailing Address - Fax:808-356-1645
Practice Address - Street 1:1580 MAKALOA ST
Practice Address - Street 2:SUITE 550
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3237
Practice Address - Country:US
Practice Address - Phone:808-469-4505
Practice Address - Fax:808-356-1645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT 242251S00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health