Provider Demographics
NPI:1992568133
Name:KIA CLINICAL SERVICES
Entity type:Organization
Organization Name:KIA CLINICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BROUWERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-220-6689
Mailing Address - Street 1:PO BOX 61127
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96839-1127
Mailing Address - Country:US
Mailing Address - Phone:808-220-6689
Mailing Address - Fax:
Practice Address - Street 1:2752 WOODLAWN DR STE 5-212
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-1855
Practice Address - Country:US
Practice Address - Phone:808-339-3046
Practice Address - Fax:808-339-3047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health