Provider Demographics
NPI:1740970581
Name:KOGA, KIMBERLY C (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:C
Last Name:KOGA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 HOOKANO ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3410
Mailing Address - Country:US
Mailing Address - Phone:808-445-8425
Mailing Address - Fax:
Practice Address - Street 1:2148 AWAPUHI STREET
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5290
Practice Address - Country:US
Practice Address - Phone:808-365-8128
Practice Address - Fax:808-961-6383
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HISP-1364235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist