Healthcare Provider Details

I. General information

NPI: 1992568133
Provider Name (Legal Business Name): KIA CLINICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2752 WOODLAWN DR STE 5-212
HONOLULU HI
96822-1855
US

IV. Provider business mailing address

PO BOX 61127
HONOLULU HI
96839-1127
US

V. Phone/Fax

Practice location:
  • Phone: 808-339-3046
  • Fax: 808-339-3047
Mailing address:
  • Phone: 808-220-6689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GERALD BROUWERS
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 808-220-6689