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General NPI Number Information
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NPI Number | 1356149892
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Entity Type | Organization
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Legal Business Name | MAKANA NORTH SHORE DERMATOLOGY
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 4488 HANALEI PLANTATION RD
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City | PRINCEVILLE
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State | HI
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Zip | 96722-5462
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Country | US
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Telephone | 808-320-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 4488 HANALEI PLANTATION RD
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City | PRINCEVILLE
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State | HI
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Zip | 96722-5462
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Country | US
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Telephone | 808-320-7300
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Fax |
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Authorized Official
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Title or Position | SOLE MBR
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Name | DR. EDWARD KIMBALL
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Credential | MD
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Telephone | 801-910-1963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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