Provider Demographics
NPI:1649498361
Name:KAWAKAMI, CARL KIYOSHI
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:KIYOSHI
Last Name:KAWAKAMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-106 LELEUA PL
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2123
Mailing Address - Country:US
Mailing Address - Phone:808-235-8633
Mailing Address - Fax:
Practice Address - Street 1:1500 S BERETANIA ST
Practice Address - Street 2:SUITE 402
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1932
Practice Address - Country:US
Practice Address - Phone:808-945-3690
Practice Address - Fax:808-945-2811
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILSW-4791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical