Healthcare Provider Details

I. General information

NPI: 1578302915
Provider Name (Legal Business Name): KUKUNAOKALA PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-730 FARRINGTON HWY, SUITE 401
WAIPAHU HI
96797
US

IV. Provider business mailing address

94-229 WAIPAHU DEPOT ST STE 401
WAIPAHU HI
96797-3034
US

V. Phone/Fax

Practice location:
  • Phone: 808-691-0992
  • Fax:
Mailing address:
  • Phone: 808-691-0992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. LEVI PARK
Title or Position: PARTNER / PSYCHOLOGIST
Credential: PSY.D.
Phone: 808-691-0992