=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023242724
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRUDY NARIKIYO GUO, PH.D., LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2009
-----------------------------------------------------
Last Update Date | 03/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1050 QUEEN ST STE 100
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96814-4130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-591-2533
-----------------------------------------------------
Fax | 808-599-2544
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2101 NUUANU AVE APT 1801
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96817-1768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SINGLE OWNER
-----------------------------------------------------
Name | DR. TRUDY NARIKIYO GUO
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 808-591-2533
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PSY-469
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------