Healthcare Provider Details

I. General information

NPI: 1548520109
Provider Name (Legal Business Name): RIO KENJI COLE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 ULUKAHIKI ST
KAILUA HI
96734-4454
US

IV. Provider business mailing address

1040 KINAU ST #604
HONOLULU HI
96814-1028
US

V. Phone/Fax

Practice location:
  • Phone: 808-263-5500
  • Fax:
Mailing address:
  • Phone: 808-345-9014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number1658
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: