Healthcare Provider Details

I. General information

NPI: 1407351034
Provider Name (Legal Business Name): KEVIN JAMES YEUNG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 LUSITANA ST STE 609
HONOLULU HI
96813-2431
US

IV. Provider business mailing address

1288 ALA MOANA BLVD APT 19E
HONOLULU HI
96814-4293
US

V. Phone/Fax

Practice location:
  • Phone: 808-892-0929
  • Fax:
Mailing address:
  • Phone: 415-990-0912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDOS-2205-0
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: