Healthcare Provider Details

I. General information

NPI: 1871591362
Provider Name (Legal Business Name): KENNETH ALAN HIRSCH MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HEALTH CLINIC PEARL HARBOR
PEARL HARBOR HI
96860
US

IV. Provider business mailing address

2180 HALAKAU ST
HONOLULU HI
96821-2604
US

V. Phone/Fax

Practice location:
  • Phone: 808-473-1880
  • Fax: 808-473-2144
Mailing address:
  • Phone: 808-473-1880
  • Fax: 808-473-2144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG75716
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: