=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265966964
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PSYCHIATRY GROUP HAWAII LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2017
-----------------------------------------------------
Last Update Date | 03/01/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2855 E MANOA RD STE 105 #337
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96822-1854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-234-3421
-----------------------------------------------------
Fax | 808-797-2422
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2855 E MANOA RD STE 105 #337
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96822-1854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-234-3421
-----------------------------------------------------
Fax | 808-797-2422
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. STACY NOBUKO UYEKUBO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 808-234-3421
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number | 14770
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------