Healthcare Provider Details

I. General information

NPI: 1265966964
Provider Name (Legal Business Name): PSYCHIATRY GROUP HAWAII LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 E MANOA RD STE 105 #337
HONOLULU HI
96822-1854
US

IV. Provider business mailing address

2855 E MANOA RD STE 105 #337
HONOLULU HI
96822-1854
US

V. Phone/Fax

Practice location:
  • Phone: 808-234-3421
  • Fax: 808-797-2422
Mailing address:
  • Phone: 808-234-3421
  • Fax: 808-797-2422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number14770
License Number StateHI

VIII. Authorized Official

Name: DR. STACY NOBUKO UYEKUBO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 808-234-3421