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General NPI Number Information
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NPI Number | 1487980769
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Entity Type | Individual
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Provider Name | KAORI MITA BERRY L.AC
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Gender | Female
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Dates
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Enumeration Date | 10/21/2009
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 2570 S BERETANIA ST SUITE 205
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City | HONOLULU
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State | HI
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Zip | 96826-1594
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Country | US
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Telephone | 808-262-6565
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Fax |
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Provider Business Mailing Address
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Address Line | 425 ENA RD PH6C
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City | HONOLULU
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State | HI
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Zip | 96815-1746
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Country | US
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Telephone | 808-226-0135
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Fax | 808-955-5328
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 900
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 246ZA2600X
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Taxonomy Name | Medical Art Specialist/Technologist
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License Number | 3359
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License Number State | HI
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