=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639229008
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAILUA DERMATOLOGY ASSOCIATES LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2007
-----------------------------------------------------
Last Update Date | 02/11/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 AULIKE ST SUITE 311
-----------------------------------------------------
City | KAILUA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96734-2758
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-261-6133
-----------------------------------------------------
Fax | 808-262-9222
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40 AULIKE ST SUITE 311
-----------------------------------------------------
City | KAILUA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96734-2758
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-261-6133
-----------------------------------------------------
Fax | 808-262-9222
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. PHILIP DAVID HELLREICH
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 808-261-6133
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 2088
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------