Healthcare Provider Details

I. General information

NPI: 1477675478
Provider Name (Legal Business Name): KENT BOOHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45-710 KEAAHALA RD HAWAII STATE HOSPITAL
KANEOHE HI
96744-3528
US

IV. Provider business mailing address

45-710 KEAAHALA RD HAWAII STATE HOSPITAL
KANEOHE HI
96744-3528
US

V. Phone/Fax

Practice location:
  • Phone: 808-247-2191
  • Fax: 808-236-8337
Mailing address:
  • Phone: 808-247-2191
  • Fax: 808-236-8337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD-12327
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD 12327
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: