Provider Demographics
NPI:1831333061
Name:KEPOO, CHARIS YOSHIE KEALAKAI
Entity type:Individual
Prefix:MS
First Name:CHARIS
Middle Name:YOSHIE KEALAKAI
Last Name:KEPOO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 NOELANI ST
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2076
Mailing Address - Country:US
Mailing Address - Phone:808-398-3247
Mailing Address - Fax:808-455-2484
Practice Address - Street 1:1709 NOELANI ST
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2076
Practice Address - Country:US
Practice Address - Phone:808-398-3247
Practice Address - Fax:808-455-2484
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT 10666171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor