Healthcare Provider Details

I. General information

NPI: 1376780650
Provider Name (Legal Business Name): KAI MATTHES M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MAHALANI ST
WAILUKU HI
96793-2526
US

IV. Provider business mailing address

PO BOX 3270
HONOLULU HI
96801-3270
US

V. Phone/Fax

Practice location:
  • Phone: 808-442-5064
  • Fax: 808-442-5067
Mailing address:
  • Phone: 808-538-3232
  • Fax: 808-538-3220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number225504
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD-18269
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: