Healthcare Provider Details

I. General information

NPI: 1619188216
Provider Name (Legal Business Name): KATHERINE LYNNE METZGER DIETRICH D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 IWILEI RD
HONOLULU HI
96817-5018
US

IV. Provider business mailing address

1177 QUEEN ST APT 4603
HONOLULU HI
96814-4152
US

V. Phone/Fax

Practice location:
  • Phone: 808-383-3996
  • Fax: 808-791-8049
Mailing address:
  • Phone: 406-606-2168
  • Fax: 84-330-2818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number005587
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number40873
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberDOS-2646
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: