Healthcare Provider Details

I. General information

NPI: 1750271235
Provider Name (Legal Business Name): DR. FOOT HAWAII LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 HEKILI ST STE 120
KAILUA HI
96734-2820
US

IV. Provider business mailing address

151 HEKILI ST STE 120
KAILUA HI
96734-2820
US

V. Phone/Fax

Practice location:
  • Phone: 808-888-0431
  • Fax:
Mailing address:
  • Phone: 808-888-0431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER LEE
Title or Position: MEMBER
Credential: DPM
Phone: 808-888-0431