Healthcare Provider Details

I. General information

NPI: 1780243089
Provider Name (Legal Business Name): ANDREW K. N. KINIMAKA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3288 MOANALUA RD
HONOLULU HI
96819-1469
US

IV. Provider business mailing address

3288 MOANALUA RD
HONOLULU HI
96819-1469
US

V. Phone/Fax

Practice location:
  • Phone: 808-432-0000
  • Fax:
Mailing address:
  • Phone: 808-432-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMDR-7737
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-22684
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: