=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508733114
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZEN KAIAULU LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2025
-----------------------------------------------------
Last Update Date | 10/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 75-6016 ALII DR
-----------------------------------------------------
City | KAILUA KONA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96740-2365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-822-5669
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 N VINEYARD BLVD STE A325-222
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96817-3950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HEALTH COACH
-----------------------------------------------------
Name | DR. JOHN W YOUNG JR.
-----------------------------------------------------
Credential | DSC
-----------------------------------------------------
Telephone | 703-822-5669
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------