Provider Demographics
NPI:1366200446
Name:DR KEITH LLC
Entity type:Organization
Organization Name:DR KEITH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDRO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-382-2049
Mailing Address - Street 1:1670 MAKALOA ST # 204-212
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3232
Mailing Address - Country:US
Mailing Address - Phone:808-382-2049
Mailing Address - Fax:808-745-1799
Practice Address - Street 1:1060 YOUNG ST STE 222
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1609
Practice Address - Country:US
Practice Address - Phone:808-382-2049
Practice Address - Fax:808-745-1799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty