Healthcare Provider Details

I. General information

NPI: 1093989139
Provider Name (Legal Business Name): KENNEAL Y C CHUN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 LUSITANA ST SUITE 407
HONOLULU HI
96813-2429
US

IV. Provider business mailing address

1329 LUSITANA ST SUITE 407
HONOLULU HI
96813-2429
US

V. Phone/Fax

Practice location:
  • Phone: 808-533-3368
  • Fax: 808-536-4849
Mailing address:
  • Phone: 808-533-3368
  • Fax: 808-536-4849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD3029
License Number StateHI

VIII. Authorized Official

Name: GERMAINE LARIOZA
Title or Position: BILLER
Credential:
Phone: 808-533-3368