Healthcare Provider Details

I. General information

NPI: 1396791851
Provider Name (Legal Business Name): KRISTEN TAFT HOUGLAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST
HONOLULU HI
96826-1001
US

IV. Provider business mailing address

PO BOX 737
HAWLEYVILLE CT
06440-0737
US

V. Phone/Fax

Practice location:
  • Phone: 808-983-6940
  • Fax:
Mailing address:
  • Phone: 626-755-0791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA92714
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number01072126A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number54809
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number18925
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: