Healthcare Provider Details

I. General information

NPI: 1679755375
Provider Name (Legal Business Name): KEVIN P CHRISTENSEN, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 LUSITANA ST SUITE 501
HONOLULU HI
96813-2429
US

IV. Provider business mailing address

1329 LUSITANA ST SUITE 501
HONOLULU HI
96813-2429
US

V. Phone/Fax

Practice location:
  • Phone: 808-522-9633
  • Fax: 808-522-9646
Mailing address:
  • Phone: 808-522-9633
  • Fax: 808-522-9646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number13159
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG4914
License Number StateTX

VIII. Authorized Official

Name: DR. KEVIN PETER CHRISTENSEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 808-522-9633