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General NPI Number Information
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NPI Number | 1588292759
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Entity Type | Organization
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Legal Business Name | KOEMI WELLNESS, LLC
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Dates
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Enumeration Date | 03/31/2020
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Last Update Date | 07/24/2020
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Provider Practice Location Address
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Address Line | 1029 KAPAHULU AVE STE 405
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City | HONOLULU
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State | HI
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Zip | 96816-1332
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Country | US
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Telephone | 808-650-8512
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 283131
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City | HONOLULU
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State | HI
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Zip | 96828-3131
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | ERIN OGAWA
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Credential | PSYD, CSAC
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Telephone | 808-650-8512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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