Provider Demographics
NPI:1831742428
Name:TSURU, GARYN KEN (PHD)
Entity type:Individual
Prefix:DR
First Name:GARYN
Middle Name:KEN
Last Name:TSURU
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 LIME ST APT A
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-3854
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1832 LIME ST APT A
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-3854
Practice Address - Country:US
Practice Address - Phone:808-394-2800
Practice Address - Fax:562-245-6419
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-1781103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist