Healthcare Provider Details

I. General information

NPI: 1932980448
Provider Name (Legal Business Name): KUPUKUPU CONSULTING HAWAII, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65-1692 KOHALA MOUNTAIN RD
KAMUELA HI
96743-8476
US

IV. Provider business mailing address

67-1185 MAMALAHOA HWY D104 #115
KAMUELA HI
96743
US

V. Phone/Fax

Practice location:
  • Phone: 808-300-9059
  • Fax:
Mailing address:
  • Phone: 808-300-9059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: JON RAY BAMBA
Title or Position: CO-FOUNDER
Credential: BCBA, LBA
Phone: 808-300-9059