Healthcare Provider Details

I. General information

NPI: 1215128210
Provider Name (Legal Business Name): KEITH K. ABE, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST STE 999
HONOLULU HI
96826-1077
US

IV. Provider business mailing address

1319 PUNAHOU ST STE 999
HONOLULU HI
96826-1077
US

V. Phone/Fax

Practice location:
  • Phone: 808-947-1402
  • Fax: 808-941-9304
Mailing address:
  • Phone: 808-947-1402
  • Fax: 808-941-9304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-12767
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberMD-12767
License Number StateHI

VIII. Authorized Official

Name: DR. KEITH K ABE
Title or Position: OWNER
Credential: M.D.
Phone: 808-947-1402