Provider Demographics
NPI:1306329396
Name:KUDRYN, NATALIYA
Entity type:Individual
Prefix:
First Name:NATALIYA
Middle Name:
Last Name:KUDRYN
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 1:65-1279 KAWAIHAE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8444
Mailing Address - Country:US
Mailing Address - Phone:808-887-0747
Mailing Address - Fax:
Practice Address - Street 1:65-1279 KAWAIHAE RD STE 201
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8444
Practice Address - Country:US
Practice Address - Phone:808-887-0747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIXLQ0002331946Medicaid