Healthcare Provider Details

I. General information

NPI: 1609159763
Provider Name (Legal Business Name): KERRY A. LAU PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 PONAHAWAI ST STE 214
HILO HI
96720-7830
US

IV. Provider business mailing address

670 PONAHAWAI ST STE 214
HILO HI
96720-7830
US

V. Phone/Fax

Practice location:
  • Phone: 808-969-3331
  • Fax: 808-935-6175
Mailing address:
  • Phone: 808-969-3331
  • Fax: 808-935-6175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAMD502
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00260300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: