Healthcare Provider Details

I. General information

NPI: 1104902170
Provider Name (Legal Business Name): JONI D KROLL D.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 ULUNIU ST SUITE 2
KAILUA HI
96734-2529
US

IV. Provider business mailing address

320 ULUNIU ST SUITE 2
KAILUA HI
96734-2529
US

V. Phone/Fax

Practice location:
  • Phone: 808-262-4550
  • Fax: 808-261-7770
Mailing address:
  • Phone: 808-262-4550
  • Fax: 808-261-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACU 240
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: