Individual
SAGE K K FANENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1001 KAMOKILA BLVD STE 210, KAPOLEI, HI 96707-2096
(808) 591-6060
Mailing address
169 HAUOLA AVE, WAHIAWA, HI 96786-2303
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-296043
HI
Other
Enumeration date
09/13/2023
Last updated
09/13/2023
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