Healthcare Provider Details

I. General information

NPI: 1134346737
Provider Name (Legal Business Name): KENNETH T. KAAN, MD., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 05/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 LUSITANA ST STE 206
HONOLULU HI
96813-2411
US

IV. Provider business mailing address

1329 LUSITANA ST STE 206
HONOLULU HI
96813-2411
US

V. Phone/Fax

Practice location:
  • Phone: 808-533-3393
  • Fax: 808-533-1448
Mailing address:
  • Phone: 808-533-3393
  • Fax: 808-533-1448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD4194
License Number StateHI

VIII. Authorized Official

Name: DR. KENNETH T KAAN
Title or Position: PRESIDENT
Credential: MD
Phone: 808-533-3393