Healthcare Provider Details

I. General information

NPI: 1881917326
Provider Name (Legal Business Name): KISTNER VEIN CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 S BERETANIA ST SUITE 307
HONOLULU HI
96813-2551
US

IV. Provider business mailing address

PO BOX 25668
HONOLULU HI
96825-0668
US

V. Phone/Fax

Practice location:
  • Phone: 808-532-8346
  • Fax: 808-532-2240
Mailing address:
  • Phone: 808-536-0300
  • Fax: 808-536-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD1571
License Number StateHI

VIII. Authorized Official

Name: DR. ROBERT L KISTNER
Title or Position: OWNER
Credential: M.D.
Phone: 808-532-8346