Healthcare Provider Details

I. General information

NPI: 1275896433
Provider Name (Legal Business Name): KRISTINE LAYUGAN SHANER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINE ULEP LAYUGAN M.D.

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 LILIHA ST STE 404
HONOLULU HI
96817-3563
US

IV. Provider business mailing address

86-260 FARRINGTON HWY
WAIANAE HI
96792-3128
US

V. Phone/Fax

Practice location:
  • Phone: 808-545-3567
  • Fax: 808-545-3568
Mailing address:
  • Phone: 808-697-3433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18287
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: