Organization
KINTSUGI CENTER FOR HEALING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE PHAN PSY.D. (OWNER/CEO)
(408) 614-4854
Entity
Organization
Contact information
Practice address
98-211 PALI MOMI ST STE 600, AIEA, HI 96701-4337
(808) 201-9059
Mailing address
91-1014 ALEPA ST, KAPOLEI, HI 96707-1901
(408) 614-4854
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
10/23/2023
Last updated
10/23/2023
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