Healthcare Provider Details

I. General information

NPI: 1326028416
Provider Name (Legal Business Name): KAZU HERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JARRETT WHITE RD TRIPLER ARMY MEDICAL CENTER ATTN: MCHK-QS
TRIPLER AMC HI
96859-5001
US

IV. Provider business mailing address

1 JARRETT WHITE RD
TRIPLER ARMY MEDICAL CENTER HI
96859-5001
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-2460
  • Fax: 808-433-1558
Mailing address:
  • Phone: 808-433-8553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD11873
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD11873
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: