Healthcare Provider Details

I. General information

NPI: 1770034886
Provider Name (Legal Business Name): DR. KEN KALEI HUFFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 CENTRAL AVE
PEARL HARBOR HI
96860-4908
US

IV. Provider business mailing address

200 MERCY CIRCLE
CAMP PENDLETON CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 808-474-4242
  • Fax:
Mailing address:
  • Phone: 760-725-5419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6898937-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: