Healthcare Provider Details

I. General information

NPI: 1750364527
Provider Name (Legal Business Name): SUSAN KISS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUZI KISS PSY.D.

II. Dates (important events)

Enumeration Date: 11/24/2005
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2875 S KING ST SUITE 203
HONOLULU HI
96826-3564
US

IV. Provider business mailing address

2875 S KING ST SUITE 203
HONOLULU HI
96826-3564
US

V. Phone/Fax

Practice location:
  • Phone: 808-944-6900
  • Fax: 808-944-6922
Mailing address:
  • Phone: 808-944-6900
  • Fax: 808-944-6922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-721
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: