Healthcare Provider Details

I. General information

NPI: 1063636405
Provider Name (Legal Business Name): KIMBERLEY M. I. WIRSING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 MAHALANI ST
WAILUKU HI
96793-2531
US

IV. Provider business mailing address

80 MAHALANI ST
WAILUKU HI
96793-2531
US

V. Phone/Fax

Practice location:
  • Phone: 808-243-6000
  • Fax:
Mailing address:
  • Phone: 808-243-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD-14771
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA85063
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberMD-14771
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: