Healthcare Provider Details

I. General information

NPI: 1548292543
Provider Name (Legal Business Name): C. MITCHELL JENKINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4469 WAIALO RD
ELEELE HI
96705
US

IV. Provider business mailing address

PO BOX 51014
ELEELE HI
96705-1014
US

V. Phone/Fax

Practice location:
  • Phone: 808-335-0579
  • Fax: 808-335-0581
Mailing address:
  • Phone: 808-335-0579
  • Fax: 808-335-0581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-7755
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: