Healthcare Provider Details

I. General information

NPI: 1790291011
Provider Name (Legal Business Name): MICHAEL KUKAHIWA-HARUNO MS, RBT-15-07111
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HEKILI ST STE A124
KAILUA HI
96734-2800
US

IV. Provider business mailing address

91-1081 IWIKUAMOO ST APT 1105
EWA BEACH HI
96706-5810
US

V. Phone/Fax

Practice location:
  • Phone: 808-427-4750
  • Fax: 808-909-2004
Mailing address:
  • Phone: 808-782-5456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-15-07111
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC-726
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: