Ka Imi Pono, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

899 Issued in HI

Legal business name

KA IMI PONO, LLC

Practice address

1029 Kapahulu Ave Ste 405
Honolulu, HI 96816-1332

Phone

(808) 387-5307

Fax

(808) 218-7884

NPI assigned

Jan 28, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gail Lynn Tice, PSY.D.NPI 1225133481

Title

Clinical Psychologist

Phone

(808) 387-5307

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in HI

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gail Lynn Tice, PSY.D.

  • Psychologist
  • Honolulu, HI
  • NPI 1225133481
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201478400000",
    "number": "1083891469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 161191",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968160925",
            "telephone_number": "808-387-5307",
            "fax_number": "808-218-7884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1029 KAPAHULU AVE STE 405",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968161332",
            "telephone_number": "808-387-5307",
            "fax_number": "808-218-7884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KA IMI PONO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-28",
        "last_updated": "2008-01-28",
        "status": "A",
        "authorized_official_last_name": "TICE",
        "authorized_official_first_name": "GAIL",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "808-387-5307",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "HI",
            "license": "899",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL NPI",
            "identifier": "1225133481",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Honolulu, HI
• Providers in Honolulu, HI by specialty
• Clinical Psychologist in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.