Healthcare Provider Details

I. General information

NPI: 1366034894
Provider Name (Legal Business Name): THE KIDS DOC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579 FARRINGTON HWY STE 203
KAPOLEI HI
96707-2027
US

IV. Provider business mailing address

579 FARRINGTON HWY STE 203
KAPOLEI HI
96707-2027
US

V. Phone/Fax

Practice location:
  • Phone: 808-674-2555
  • Fax: 808-674-2988
Mailing address:
  • Phone: 808-674-2555
  • Fax: 808-674-2988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NARO L TORRES
Title or Position: OWNER/MD
Credential: MD
Phone: 808-674-2555