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General NPI Number Information
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NPI Number | 1619354230
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Entity Type | Organization
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Legal Business Name | KAILUA COMFORT CLINIC
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Dates
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Enumeration Date | 05/04/2015
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Last Update Date | 05/04/2015
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Provider Practice Location Address
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Address Line | 407 ULUNIU ST STE 412
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City | KAILUA
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State | HI
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Zip | 96734-2544
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Country | US
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Telephone | 808-633-6569
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Fax |
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Provider Business Mailing Address
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Address Line | 407 ULUNIU ST, #412
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City | KAILUA
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State | HI
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Zip | 96734
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Country | US
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Telephone | 808-633-6569
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Fax | 808-230-2476
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Authorized Official
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Title or Position | CEO AND STAFF
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Name | DR. DANIEL LEV
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Credential | PSYCHOLOGIST
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Telephone | 808-633-6569
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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 | PSY 1067
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License Number State | HI
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