Healthcare Provider Details

I. General information

NPI: 1497048441
Provider Name (Legal Business Name): CHARLTON MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 ULUKAHIKI ST
KAILUA HI
96734-4454
US

IV. Provider business mailing address

PO BOX 970809
WAIPAHU HI
96797-0809
US

V. Phone/Fax

Practice location:
  • Phone: 808-664-1104
  • Fax: 866-592-3149
Mailing address:
  • Phone: 808-664-1104
  • Fax: 866-592-3149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD11530
License Number StateHI

VIII. Authorized Official

Name: KIMBERLY A CHARLTON
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 808-664-1104