Healthcare Provider Details

I. General information

NPI: 1093782682
Provider Name (Legal Business Name): JENNIFER WAIRIMU MBUTHIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PUNCHBOWL ST
HONOLULU HI
96813-2499
US

IV. Provider business mailing address

6900 GEORGIA AVE NW DEPT OF ALLERGY.IMMUNOLOGY
WASHINGTON DC
20307-0003
US

V. Phone/Fax

Practice location:
  • Phone: 808-691-1000
  • Fax:
Mailing address:
  • Phone: 202-782-0411
  • Fax: 202-782-4658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-11847
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD-11847
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: