Healthcare Provider Details

I. General information

NPI: 1417720350
Provider Name (Legal Business Name): MS. LORI-ANN AMODO SOON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 11/02/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 KAPAA QUARRY PL.
KAILUA HI
96734
US

IV. Provider business mailing address

2071 MAHAOO PL
HONOLULU HI
96819-1659
US

V. Phone/Fax

Practice location:
  • Phone: 808-247-2973
  • Fax: 808-427-3472
Mailing address:
  • Phone: 808-203-0917
  • 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: