Provider Demographics
NPI:1952019531
Name:LOOK, BRAYDN
Entity Type:Individual
Prefix:
First Name:BRAYDN
Middle Name:
Last Name:LOOK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-423 IKEPONO ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-1619
Mailing Address - Country:US
Mailing Address - Phone:808-343-0944
Mailing Address - Fax:
Practice Address - Street 1:94-423 IKEPONO ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1619
Practice Address - Country:US
Practice Address - Phone:808-343-0944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician