Healthcare Provider Details

I. General information

NPI: 1376200063
Provider Name (Legal Business Name): KRISTIE W YEUNG MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N KUAKINI ST STE 308
HONOLULU HI
96817-2360
US

IV. Provider business mailing address

680 IWILEI RD STE 500
HONOLULU HI
96817-5389
US

V. Phone/Fax

Practice location:
  • Phone: 808-440-6852
  • Fax: 808-440-6878
Mailing address:
  • Phone: 808-848-8000
  • Fax: 808-848-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number284-LD
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: