Provider Demographics
NPI:1679781421
Name:HULL, PHILIP VERYAN (PHD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:VERYAN
Last Name:HULL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 GRAND AVE # 422
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4840
Mailing Address - Country:US
Mailing Address - Phone:808-371-5666
Mailing Address - Fax:
Practice Address - Street 1:3501 NUUANU PALI DR
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5216
Practice Address - Country:US
Practice Address - Phone:808-371-5666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY563103TC0700X
CAPSY13858103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI20869-4Medicaid
HIS30005Medicare UPIN