Healthcare Provider Details

I. General information

NPI: 1871470419
Provider Name (Legal Business Name): KEVIN JAMES HOLDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 S KING ST STE 218B
HONOLULU HI
96814-1703
US

IV. Provider business mailing address

94-829 KALAIAHA PL
WAIPAHU HI
96797-4527
US

V. Phone/Fax

Practice location:
  • Phone: 808-748-7552
  • Fax:
Mailing address:
  • Phone: 702-858-2694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License NumberR6940
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number432278
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: