Healthcare Provider Details

I. General information

NPI: 1972252526
Provider Name (Legal Business Name): KIDS THRIVE PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2022
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

94-1024 HOAINAU ST
WAIPAHU HI
96797-3272
US

V. Phone/Fax

Practice location:
  • Phone: 808-545-3567
  • Fax: 808-545-3568
Mailing address:
  • Phone: 808-349-6128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISTINE LAYUGAN SHANER
Title or Position: OWNER/PEDIATRICIAN
Credential: MD
Phone: 808-545-3567