Blossom Iwalani Fonoimoana, PSYD, MSW, LSW

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY-1524 Issued in HI

Practice address

604 Maunaloa Hwy
#C
Kaunakakai, HI 96748-0130

Phone

(808) 560-3653

Fax

(808) 560-3385

NPI assigned

Dec 2, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/21516/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• NA Pu'Uwai

  • Adult Day Care Clinic/Center
  • Kaunakakai, HI
  • NPI 1447782123
  NPD (past)

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

{
    "created_epoch": "1228176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538006400000",
    "number": "1619112877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56-660 KAMEHAMEHA HWY",
            "city": "KAHUKU",
            "state": "HI",
            "postal_code": "967312210",
            "telephone_number": "808-293-7555",
            "fax_number": "808-293-7196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 MAUNALOA HWY",
            "address_2": "#C",
            "city": "KAUNAKAKAI",
            "state": "HI",
            "postal_code": "967480130",
            "telephone_number": "808-560-3653",
            "fax_number": "808-560-3385"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "832 Kiele St",
            "address_purpose": "LOCATION",
            "city": "Lanai City",
            "state": "HI",
            "postal_code": "967480713",
            "country_code": "US",
            "telephone_number": "808-565-7204",
            "fax_number": "808-565-9319",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "56-660 Kamehameha Hwy",
            "address_purpose": "LOCATION",
            "city": "Kahuku",
            "state": "HI",
            "postal_code": "967312210",
            "country_code": "US",
            "telephone_number": "808-293-7555",
            "fax_number": "808-293-7196",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FONOIMOANA",
        "first_name": "BLOSSOM",
        "middle_name": "IWALANI",
        "name_prefix": "Dr.",
        "credential": "PSYD, MSW, LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-02",
        "last_updated": "2018-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "HI",
            "license": "LSW 1557",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "HI",
            "license": "PSY-1524",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "HI",
            "license": "LCSW-3658",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wendy Christine Doenges
• Autumn U Dowling, DNP, APRN-RX, FNP-BC
• Charity Dudoit, LMFT
• Eye Place Molokai
• Ardis Farris, BEHAVIOR TECHNICIAN
• Lailani Frericks, MSW, MS
• Donna L Gamiao, RN, CDE
• Paula Renee Gardner, D.D.S.
• Kelly Go, RPH
• Kurt C.L. Go, ATC, RD/LD, LMT

• Psychologist in Kaunakakai, HI
• Providers in Kaunakakai, HI by specialty
• Psychologist in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.