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General NPI Number Information
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NPI Number | 1316903610
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Entity Type | Individual
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Provider Name | TYRIE LEE JENKINS M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 02/03/2017
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Provider Practice Location Address
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Address Line | 615 PIIKOI ST SUITE 205
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City | HONOLULU
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State | HI
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Zip | 96814-3139
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Country | US
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Telephone | 808-591-9911
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Fax | 808-591-9909
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Provider Business Mailing Address
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Address Line | PO BOX 31000 SUITE 205
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City | HONOLULU
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State | HI
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Zip | 96849-5684
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Country | US
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Telephone | 808-591-9911
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Fax | 808-697-5488
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MD5046
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD5046
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License Number State | HI
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