Healthcare Provider Details

I. General information

NPI: 1417062092
Provider Name (Legal Business Name): MEK MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 KOAE ST
HONOLULU HI
96816-5004
US

IV. Provider business mailing address

929 KOAE ST
HONOLULU HI
96816-5004
US

V. Phone/Fax

Practice location:
  • Phone: 808-734-1130
  • Fax: 808-734-4425
Mailing address:
  • Phone: 808-221-2161
  • Fax: 808-734-4425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberHI12656
License Number StateHI

VIII. Authorized Official

Name: DR. MARC EVAN KRUGER
Title or Position: PRESIDENT / CEO
Credential: MD
Phone: 808-221-2161