Provider Demographics
NPI:1457775272
Name:YUEN, FRED KEKINO (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:KEKINO
Last Name:YUEN
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22005
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96823-2005
Mailing Address - Country:US
Mailing Address - Phone:808-780-0014
Mailing Address - Fax:808-356-1609
Practice Address - Street 1:710 PALEKAUA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-4755
Practice Address - Country:US
Practice Address - Phone:808-780-0014
Practice Address - Fax:808-356-1609
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1-13-14877103K00000X
HIBA27103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-13-14877OtherBCBA