Provider Demographics
NPI:1740329036
Name:FUJIMOTO, KEVIN LEE (PSYD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:LEE
Last Name:FUJIMOTO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-955 KAMEHAMEHA HWY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3222
Mailing Address - Country:US
Mailing Address - Phone:808-218-8733
Mailing Address - Fax:
Practice Address - Street 1:45-955 KAMEHAMEHA HWY
Practice Address - Street 2:SUITE 206
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3222
Practice Address - Country:US
Practice Address - Phone:808-218-8733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY861103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIA0247641OtherHMSA PROVIDER #