Healthcare Provider Details

I. General information

NPI: 1740857101
Provider Name (Legal Business Name): PSYCHIATRIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1247 KAAHUMANU ST STE 116
AIEA HI
96701-5300
US

IV. Provider business mailing address

98-1247 KAAHUMANU ST STE 116
AIEA HI
96701-5300
US

V. Phone/Fax

Practice location:
  • Phone: 808-762-0911
  • Fax: 808-626-5161
Mailing address:
  • Phone: 808-762-0911
  • Fax: 808-626-5161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: CINDY WU
Title or Position: CLINICAL MANAGER
Credential: RN
Phone: 808-728-0484