MEDICARE: DR. EDWARD SAM KUBANY PH.D.

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	103TC0700X	Clinical Psychologist	72	HI

General Provider Information

NPI Number	:	1639271463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD SAM KUBANY PH.D.

Provider Business Mailing Address
First Line	:	7141 KUKII ST
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96825-1601
Country	:	US
Telephone Number	:	808-395-0092
Fax Number	:	808-395-0092

Provider Business Practice Location Address
First Line	:	4211 WAIALAE AVE
Second Line	:	SUITE 206A
City	:	HONOLULU
State	:	HI
Zip	:	96816-5306
Country	:	US
Telephone Number	:	808-284-4497
Fax Number	:	808-735-2495

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	04/12/2026

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