=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386869691
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GINA ANN LEONG SAMALA PSY.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2007
-----------------------------------------------------
Last Update Date | 02/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 KAHELU AVE STE 232
-----------------------------------------------------
City | MILILANI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96789-3962
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-625-7448
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 125
-----------------------------------------------------
City | WAIALUA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96791-0125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-625-7448
-----------------------------------------------------
Fax | 808-200-1186
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY-756
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------