Healthcare Provider Details

I. General information

NPI: 1992635023
Provider Name (Legal Business Name): ERIC WAYNE KU'ULEI KNIGHTEN APCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23470 OLIVE WOOD PLAZA DR
MORENO VALLEY CA
92553-5264
US

IV. Provider business mailing address

1379 E CYPRESS AVE
GLENDORA CA
91741-2924
US

V. Phone/Fax

Practice location:
  • Phone: 626-251-7428
  • Fax:
Mailing address:
  • Phone: 626-251-7428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAPCC20282
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: