MEDICARE: DR. KIMBERLY K HOOVERSON DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	1392	HI

General Provider Information

NPI Number	:	1598992919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY K HOOVERSON DO

Provider Business Mailing Address
First Line	:	2902 KUHIO AVE
Second Line	:	APT 1405
City	:	HONOLULU
State	:	HI
Zip	:	96815
Country	:	US
Telephone Number	:	206-227-2052
Fax Number	:

Provider Business Practice Location Address
First Line	:	1146 FORT STEEET MALL
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96813
Country	:	US
Telephone Number	:	808-940-3831
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2009
Last Update Date	:	02/15/2019

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