Healthcare Provider Details

I. General information

NPI: 1487803508
Provider Name (Legal Business Name): HAWAII KAI PSCYHIATRIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2008
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 KALANIANAOLE HWY STE 225
HONOLULU HI
96825-1273
US

IV. Provider business mailing address

PO BOX 970809
WAIPAHU HI
96797-0809
US

V. Phone/Fax

Practice location:
  • Phone: 808-342-8370
  • Fax: 808-772-4424
Mailing address:
  • Phone: 808-342-8370
  • Fax: 808-772-4424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberMD12326
License Number StateHI

VIII. Authorized Official

Name: DR. VIJAYA V VELLANKI
Title or Position: MD
Credential: MD
Phone: 808-342-8370