Healthcare Provider Details

I. General information

NPI: 1497783351
Provider Name (Legal Business Name): KENNETH DOWNARD HERBST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86-260 FARRINGTON HWY
WAIANAE HI
96792-3128
US

IV. Provider business mailing address

84-485 FARRINGTON HWY
WAIANAE HI
96792-1943
US

V. Phone/Fax

Practice location:
  • Phone: 808-697-3300
  • Fax:
Mailing address:
  • Phone: 858-405-3279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberG20622
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberG20622
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG20622
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberG20622
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number24582
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: