=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083787493
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENNETH T KAAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2006
-----------------------------------------------------
Last Update Date | 08/05/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1329 LUSITANA ST #206
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96813-2429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-533-3393
-----------------------------------------------------
Fax | 808-533-1448
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1329 LUSITANA ST #206
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96813-2429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-533-3393
-----------------------------------------------------
Fax | 808-533-1448
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MD4194
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------