Healthcare Provider Details

I. General information

NPI: 1538048095
Provider Name (Legal Business Name): KYLE YASUO MATSUNAKA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

798 KUMUKAHI PL
HONOLULU HI
96825-1103
US

IV. Provider business mailing address

798 KUMUKAHI PL
HONOLULU HI
96825-1103
US

V. Phone/Fax

Practice location:
  • Phone: 808-784-8756
  • Fax:
Mailing address:
  • Phone: 808-784-8756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberEMT-3396
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-9987-1013633
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: