Healthcare Provider Details

I. General information

NPI: 1245106574
Provider Name (Legal Business Name): CODY KANESHIRO PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 PATTERSON RD
HONOLULU HI
96819-1522
US

IV. Provider business mailing address

401 KAMAKEE ST STE 405
HONOLULU HI
96814-4261
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-0600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY1293
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-2295
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: