Healthcare Provider Details

I. General information

NPI: 1063120236
Provider Name (Legal Business Name): KEANU ARKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-450 MOKUOLA ST STE 100
WAIPAHU HI
96797-3388
US

IV. Provider business mailing address

98-1367 NOLA ST APT A
PEARL CITY HI
96782-3131
US

V. Phone/Fax

Practice location:
  • Phone: 808-944-2882
  • Fax:
Mailing address:
  • Phone: 808-387-0941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA-961-0
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-95794
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: