Healthcare Provider Details

I. General information

NPI: 1538722459
Provider Name (Legal Business Name): LINDA L. IKEDA PHD, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3627 KILAUEA AVE RM 101
HONOLULU HI
96816-2317
US

IV. Provider business mailing address

3721 KANAINA AVE APT 101
HONOLULU HI
96815-4401
US

V. Phone/Fax

Practice location:
  • Phone: 808-733-9354
  • Fax:
Mailing address:
  • Phone: 808-375-7369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: