Healthcare Provider Details

I. General information

NPI: 1063887891
Provider Name (Legal Business Name): HARUMI IZUMI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2015
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 KALAMA ST B-1
KAILUA HI
96734-2079
US

IV. Provider business mailing address

345 KALAMA ST B-1
KAILUA HI
96734
US

V. Phone/Fax

Practice location:
  • Phone: 808-284-8473
  • Fax:
Mailing address:
  • Phone: 808-284-8473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number751168273
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number751168273
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number751168273
License Number StateHI
# 4
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number751168273
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: