Provider Demographics
NPI:1720603715
Name:IWASAKI, KEVIN MASAO (SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:MASAO
Last Name:IWASAKI
Suffix:
Gender:M
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 MOHOULI ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-7210
Mailing Address - Country:US
Mailing Address - Phone:808-934-3003
Mailing Address - Fax:808-935-3783
Practice Address - Street 1:45 MOHOULI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-7210
Practice Address - Country:US
Practice Address - Phone:808-934-3003
Practice Address - Fax:808-935-3783
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILSW-2407104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker