Healthcare Provider Details

I. General information

NPI: 1386272805
Provider Name (Legal Business Name): ZACHARY CYRUS AFFRIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

687 AKOAKOA ST
KAILUA HI
96734-3910
US

V. Phone/Fax

Practice location:
  • Phone: 208-333-0845
  • Fax:
Mailing address:
  • Phone: 208-333-0845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101274028
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101274028
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberMT231617
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: