Provider Demographics
NPI:1750364527
Name:KISS, SUSAN (PSYD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KISS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:SUZI
Other - Middle Name:
Other - Last Name:KISS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:2875 S KING ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-3564
Mailing Address - Country:US
Mailing Address - Phone:808-944-6900
Mailing Address - Fax:808-944-6922
Practice Address - Street 1:2875 S KING ST
Practice Address - Street 2:SUITE 203
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-3564
Practice Address - Country:US
Practice Address - Phone:808-944-6900
Practice Address - Fax:808-944-6922
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-24
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-721103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HINONEOtherHMAA
HINONEOtherMDX
HINONEOtherHMSA
HINONEOtherUHA
HINONEOtherTRICARE
HINONEOtherINTEGRATED HEALTH PLAN
HINONEOtherHMSA QUEST
HINONEOtherSUMMERLIN
HINONEOtherHMA
HINONEMedicaid
HINONEOtherALOHACARE