=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831398973
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RANKEN, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2007
-----------------------------------------------------
Last Update Date | 07/17/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1325 S KIHEI RD STE 231
-----------------------------------------------------
City | KIHEI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96753-8180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-268-3730
-----------------------------------------------------
Fax | 877-350-2232
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 336
-----------------------------------------------------
City | KIHEI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96753-0336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-268-3730
-----------------------------------------------------
Fax | 877-350-2232
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | DR. KEVIN MARK RANKEN
-----------------------------------------------------
Credential | PSY.D., J.D.
-----------------------------------------------------
Telephone | 808-268-3730
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 923
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------