MEDICARE: HAWAII KAI PSCYHIATRIC SERVICES, LLC

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	2084P0805X	Geriatric Psychiatry Physician	MD12326	HI

General Provider Information

NPI Number	:	1487803508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAWAII KAI PSCYHIATRIC SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 970809
Second Line	:
City	:	WAIPAHU
State	:	HI
Zip	:	96797-0809
Country	:	US
Telephone Number	:	808-342-8370
Fax Number	:	808-772-4424

Provider Business Practice Location Address
First Line	:	6600 KALANIANAOLE HWY
Second Line	:	STE 225
City	:	HONOLULU
State	:	HI
Zip	:	96825-1273
Country	:	US
Telephone Number	:	808-342-8370
Fax Number	:	808-772-4424

Authorized Official
Title or Position	:	MD
Name	:	DR. VIJAYA V VELLANKI
Credential	:	MD
Telephone Number	:	808-342-8370

Provider Enumeration Date	:	09/12/2008
Last Update Date	:	09/12/2008

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