Healthcare Provider Details

I. General information

NPI: 1538107453
Provider Name (Legal Business Name): KIMBERLY KOWALSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 03/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MAHALANI ST
WAILUKU HI
96793-2526
US

IV. Provider business mailing address

2180 MAIN ST
WAILUKU HI
96793-1666
US

V. Phone/Fax

Practice location:
  • Phone: 808-442-5503
  • Fax: 808-442-5512
Mailing address:
  • Phone: 808-242-6464
  • Fax: 808-242-4212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD12493
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: