Provider Demographics
NPI:1386270551
Name:MAKINO-KAHULI, STEPHANIE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MAKINO-KAHULI
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:PO BOX 6632
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-8931
Mailing Address - Country:US
Mailing Address - Phone:808-747-4862
Mailing Address - Fax:
Practice Address - Street 1:1786 KINOOLE ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5245
Practice Address - Country:US
Practice Address - Phone:808-959-5855
Practice Address - Fax:808-959-2301
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness