Provider Demographics
NPI:1780758409
Name:KOU, MICHAEL J (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:KOU
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 1:98 1247 KAAHUMANU ST
Mailing Address - Street 2:223
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5310
Mailing Address - Country:US
Mailing Address - Phone:808-487-5433
Mailing Address - Fax:808-487-5444
Practice Address - Street 1:98 1247 KAAHUMANU ST
Practice Address - Street 2:223
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5310
Practice Address - Country:US
Practice Address - Phone:808-487-5433
Practice Address - Fax:808-487-5444
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY566103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07690001Medicaid
A010OtherTRICARE
204721OtherHMSA
0000TCBZVMedicare UPIN
0000TCBZVMedicare ID - Type Unspecified