Healthcare Provider Details

I. General information

NPI: 1902103757
Provider Name (Legal Business Name): BRENDAN KOZIK L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S MARKET ST UNIT 1-F
WAILUKU HI
96793-2217
US

IV. Provider business mailing address

22 S MARKET ST UNIT 1-F
WAILUKU HI
96793-2217
US

V. Phone/Fax

Practice location:
  • Phone: 808-242-6761
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACU-950
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: