Healthcare Provider Details

I. General information

NPI: 1750945697
Provider Name (Legal Business Name): THOMAS JAY KEOLA KANE IV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 PARKER HILL AVE
BOSTON MA
02120-3215
US

IV. Provider business mailing address

1070 AALAPAPA DR
KAILUA HI
96734-3269
US

V. Phone/Fax

Practice location:
  • Phone: 508-308-6905
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMDR-7701
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number1022620
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: