Healthcare Provider Details

I. General information

NPI: 1497158612
Provider Name (Legal Business Name): KATHRYN IZUMI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 WARD AVE
HONOLULU HI
96814-4008
US

IV. Provider business mailing address

5585 E JOAQUIN CT
COMMERCE CA
90040-1539
US

V. Phone/Fax

Practice location:
  • Phone: 808-585-1424
  • Fax:
Mailing address:
  • Phone: 323-899-3415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: