Healthcare Provider Details

I. General information

NPI: 1285353508
Provider Name (Legal Business Name): KONA FOOT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77-6403 NALANI ST STE 104
KAILUA KONA HI
96740-9763
US

IV. Provider business mailing address

PO BOX 2148
KAILUA KONA HI
96745-2148
US

V. Phone/Fax

Practice location:
  • Phone: 808-300-8606
  • Fax: 808-657-6833
Mailing address:
  • Phone: 808-300-8606
  • Fax: 808-657-6833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID CHRIS WOOD
Title or Position: MANAGING MEMBER
Credential: DPM
Phone: 808-300-8606