Healthcare Provider Details

I. General information

NPI: 1396624557
Provider Name (Legal Business Name): ANNA KLETZLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2025
Last Update Date: 08/30/2025
Certification Date: 08/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46-001 KAMEHAMEHA HWY
KANEOHE HI
96744-3711
US

IV. Provider business mailing address

55-053 NAUPAKA ST
LAIE HI
96762-1128
US

V. Phone/Fax

Practice location:
  • Phone: 808-263-5500
  • Fax:
Mailing address:
  • Phone: 385-445-3173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN-5172
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: