MEDICARE: MR. WESLEY Y. TAIRA L.C.S.W.

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	1041C0700X	Clinical Social Worker	LCSW 3964	HI

General Provider Information

NPI Number	:	1689074130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WESLEY Y. TAIRA L.C.S.W.

Provider Business Mailing Address
First Line	:	545 MANANAI PL APT U
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96818-5316
Country	:	US
Telephone Number	:	808-738-6502
Fax Number	:

Provider Business Practice Location Address
First Line	:	545 MANANAI PL APT U
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96818-5316
Country	:	US
Telephone Number	:	808-738-6502
Fax Number	:

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

Provider Enumeration Date	:	09/02/2014
Last Update Date	:	09/02/2014

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