MEDICARE: MR. DAVIN KAINOA KANE BA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	H00187733	HI

General Provider Information

NPI Number	:	1245516715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVIN KAINOA KANE BA

Provider Business Mailing Address
First Line	:	4725 MADRIGAL WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-6133
Country	:	US
Telephone Number	:	702-982-2546
Fax Number	:	702-998-6270

Provider Business Practice Location Address
First Line	:	4725 MADRIGAL WY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-6133
Country	:	US
Telephone Number	:	702-982-2546
Fax Number	:	702-998-6270

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2011
Last Update Date	:	10/28/2011

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