Healthcare Provider Details

I. General information

NPI: 1134238173
Provider Name (Legal Business Name): JOSEPH R MCKINLAY MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 BISHOP ST, PAUAHI TOWER SUITE #380
HONOLULU HI
96813-3429
US

IV. Provider business mailing address

1003 BISHOP ST, PAUAHI TOWER SUITE #380
HONOLULU HI
96813-3429
US

V. Phone/Fax

Practice location:
  • Phone: 808-528-1717
  • Fax: 808-528-1719
Mailing address:
  • Phone: 808-528-1717
  • Fax: 808-528-1719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD-10939
License Number StateHI

VIII. Authorized Official

Name: DR. JOSEPH R MCKINLAY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 808-528-1717