Healthcare Provider Details

I. General information

NPI: 1356982169
Provider Name (Legal Business Name): SEAN KIYO SAKATA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 KAPA'A QUARRY PL #5002
KAILUA HI
96734-4155
US

IV. Provider business mailing address

46-101 NAHEWAI PL
KANEOHE HI
96744-4155
US

V. Phone/Fax

Practice location:
  • Phone: 808-247-2973
  • Fax: 808-427-3472
Mailing address:
  • Phone: 808-275-6884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: