Basic Information
| Provider Information | |||||||||
| NPI: | 1467963389 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THIRAVONG | ||||||||
| FirstName: | KAWEHI | ||||||||
| MiddleName: | CHLOE | ||||||||
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| Credential: | BA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 875 WAIAMANU ST. SUITE 612 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968135248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8087916713 | ||||||||
| FaxNumber: | 8087916081 | ||||||||
| Practice Location | |||||||||
| Address1: | 875 WAIMANU ST SUITE 612 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968135248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8087916713 | ||||||||
| FaxNumber: | 8087916081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2017 | ||||||||
| LastUpdateDate: | 10/18/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.