Healthcare Provider Details

I. General information

NPI: 1396438453
Provider Name (Legal Business Name): DILLON U MOSS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ISLAND FOOT AND ANKLE SPECIALISTS LLC 415 DAIRY RD SUITE D
KAHULUI HI
96732
US

IV. Provider business mailing address

415 DAIRY RD SUITE D
KAHULUI HI
96732
US

V. Phone/Fax

Practice location:
  • Phone: 808-877-3668
  • Fax: 808-877-3248
Mailing address:
  • Phone: 808-877-3668
  • Fax: 808-877-3248

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 Code213E00000X
TaxonomyPodiatrist
License NumberPO-259
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: