Basic Information
Provider Information
NPI: 1245725944
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAU
FirstName: AKIKO
MiddleName: KATAYAMA
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1520 WARD AVE APT 204
Address2:  
City: HONOLULU
State: HI
PostalCode: 968223550
CountryCode: US
TelephoneNumber: 8083872107
FaxNumber:  
Practice Location
Address1: 4510 SALT LAKE BLVD STE D8
Address2:  
City: HONOLULU
State: HI
PostalCode: 968183172
CountryCode: US
TelephoneNumber: 8084861804
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/25/2018
LastUpdateDate: 01/12/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/12/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103K00000X  N Behavioral Health & Social Service ProvidersBehavioral Analyst 
106S00000X  Y    

No ID Information.


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