Healthcare Provider Details

I. General information

NPI: 1053974329
Provider Name (Legal Business Name): KALEO EMMSLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2019
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99-1225 AIEA HIEGHTS DRIVE
AIEA HI
96701
US

IV. Provider business mailing address

99-1225 AIEA HIEGHTS DRIVE
AIEA HI
96701
US

V. Phone/Fax

Practice location:
  • Phone: 808-457-2642
  • Fax:
Mailing address:
  • Phone: 808-457-2642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: