Healthcare Provider Details

I. General information

NPI: 1528487121
Provider Name (Legal Business Name): BRADLEY JOHN KUO FNP-BC, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MR. BRADLEY JOHN KANE

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1188 BISHOP ST STE 2602
HONOLULU HI
96813-3310
US

IV. Provider business mailing address

1188 BISHOP ST STE 2602
HONOLULU HI
96813-3310
US

V. Phone/Fax

Practice location:
  • Phone: 808-379-6656
  • Fax:
Mailing address:
  • Phone: 808-379-6656
  • Fax: 844-456-1151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1741
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1741
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: