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General NPI Number Information
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NPI Number | 1194921619
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Entity Type | Individual
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Provider Name | DAMIEN KEKANEINOA TAVARES III M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 07/27/2015
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Provider Practice Location Address
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Address Line | 2226 LILIHA STREET SUITE 407
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City | HONOLULU
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State | HI
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Zip | 96817-1600
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Country | US
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Telephone | 808-445-9172
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Fax | 808-445-9182
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Provider Business Mailing Address
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Address Line | 2226 LILIHA STREET SUITE 407
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City | HONOLULU
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State | HI
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Zip | 96817-1600
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Country | US
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Telephone | 808-445-9172
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Fax | 808-445-9182
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | MD15987
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | MD15987
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License Number State | HI
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