Provider Demographics
NPI:1063887891
Name:IZUMI, HARUMI
Entity type:Individual
Prefix:
First Name:HARUMI
Middle Name:
Last Name:IZUMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 KALAMA ST
Mailing Address - Street 2:B-1
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734
Mailing Address - Country:US
Mailing Address - Phone:808-284-8473
Mailing Address - Fax:
Practice Address - Street 1:345 KALAMA ST
Practice Address - Street 2:B-1
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2079
Practice Address - Country:US
Practice Address - Phone:808-284-8473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI751168273101YP2500X, 1223G0001X, 146N00000X, 3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1223G0001XDental ProvidersDentistGeneral Practice
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI751168273Medicaid