Healthcare Provider Details

I. General information

NPI: 1891629721
Provider Name (Legal Business Name): JUDITH KA-YENG POON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 MILLER ST
HONOLULU HI
96813-2493
US

IV. Provider business mailing address

45-479 MAKALANI ST
KANEOHE HI
96744-2824
US

V. Phone/Fax

Practice location:
  • Phone: 808-427-9257
  • Fax:
Mailing address:
  • Phone: 808-372-2938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: