Healthcare Provider Details

I. General information

NPI: 1396775573
Provider Name (Legal Business Name): EVELYN HARUMI YANAGIDA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 KALAKAUA AVE SUITE 800
HONOLULU HI
96815-1512
US

IV. Provider business mailing address

1 KEAHOLE PLACE #1504
HONOLULU HI
96825-3421
US

V. Phone/Fax

Practice location:
  • Phone: 808-947-9269
  • Fax: 808-951-9282
Mailing address:
  • Phone: 808-947-9269
  • Fax: 808-951-9282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number207
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: