Healthcare Provider Details

I. General information

NPI: 1154342962
Provider Name (Legal Business Name): JAMES M MCKINNON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MAHALANI ST
WAILUKU HI
96793-2526
US

IV. Provider business mailing address

221 MAHALANI ST
WAILUKU HI
96793-2526
US

V. Phone/Fax

Practice location:
  • Phone: 808-244-9056
  • Fax: 808-242-2488
Mailing address:
  • Phone: 808-442-5823
  • Fax: 808-442-5910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number37129
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA49889
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD61663210
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD-19609
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: