Healthcare Provider Details

I. General information

NPI: 1598758732
Provider Name (Legal Business Name): KENNETH H KERN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 OAHU AVE
HONOLULU HI
96822-2206
US

IV. Provider business mailing address

PO BOX 27684
HONOLULU HI
96827-0684
US

V. Phone/Fax

Practice location:
  • Phone: 808-595-7526
  • Fax:
Mailing address:
  • Phone: 808-595-7526
  • Fax: 808-595-2363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2580
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: