Healthcare Provider Details

I. General information

NPI: 1467400770
Provider Name (Legal Business Name): JANE KOCIVAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1883 MILL ST
WAILUKU HI
96793-1248
US

IV. Provider business mailing address

1883 MILL ST
WAILUKU HI
96793-1248
US

V. Phone/Fax

Practice location:
  • Phone: 808-244-7032
  • Fax: 808-242-0801
Mailing address:
  • Phone: 808-244-7032
  • Fax: 808-242-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4752
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: