Healthcare Provider Details

I. General information

NPI: 1184304636
Provider Name (Legal Business Name): KYLIE URATSUKA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99-080 KAUHALE ST STE C20
AIEA HI
96701-4114
US

IV. Provider business mailing address

99-080 KAUHALE ST STE C20
AIEA HI
96701-4114
US

V. Phone/Fax

Practice location:
  • Phone: 808-953-4682
  • Fax: 808-488-8535
Mailing address:
  • Phone: 808-953-4682
  • Fax: 808-488-8535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-2083
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: