Healthcare Provider Details

I. General information

NPI: 1619044120
Provider Name (Legal Business Name): HAWAII CENTER FOR REPRODUCTIVE MEDICINE AND SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 ULUKAHIKI ST SUITE 300
KAILUA HI
96734-4400
US

IV. Provider business mailing address

642 ULUKAHIKI ST SUITE 300
KAILUA HI
96734-4400
US

V. Phone/Fax

Practice location:
  • Phone: 808-261-4166
  • Fax: 808-261-4086
Mailing address:
  • Phone: 808-261-4166
  • Fax: 808-261-4086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMD9740
License Number StateHI

VIII. Authorized Official

Name: DR. KENNETH K VU
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 808-261-4166