Healthcare Provider Details

I. General information

NPI: 1194183723
Provider Name (Legal Business Name): KAIAO OLA INTEGRATIVE HEALING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65-1298B KAWAIHAE RD SUITE 21
KAMUELA HI
96743-7342
US

IV. Provider business mailing address

PO BOX 2099
KAMUELA HI
96743-2099
US

V. Phone/Fax

Practice location:
  • Phone: 808-937-9699
  • Fax: 808-885-5050
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT - 262
License Number StateHI

VIII. Authorized Official

Name: MADELYN BRUNO-KIDANI
Title or Position: MEMBER
Credential: LMFT
Phone: 808-937-9699