Healthcare Provider Details

I. General information

NPI: 1033943923
Provider Name (Legal Business Name): MR. GABRIEL KRISTOPHER PUNAHELE IZUMI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2024
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99-128 AIEA HEIGHTS DR STE 101
AIEA HI
96701-3916
US

IV. Provider business mailing address

45-135 KOKOKAHI PL
KANEOHE HI
96744-2422
US

V. Phone/Fax

Practice location:
  • Phone: 808-456-7378
  • Fax: 808-483-8822
Mailing address:
  • Phone: 808-294-2193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAMD1399
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: