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General NPI Number Information
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NPI Number | 1720605504
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Entity Type | Organization
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Legal Business Name | KEANUENUE PEDIATRICS, LLC
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Dates
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Enumeration Date | 06/29/2020
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Last Update Date | 09/25/2021
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Provider Practice Location Address
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Address Line | 615 PIIKOI ST STE 1501
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City | HONOLULU
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State | HI
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Zip | 96814-3142
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Country | US
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Telephone | 808-600-2180
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Fax | 808-600-2199
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Provider Business Mailing Address
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Address Line | 707 10TH AVE
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City | HONOLULU
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State | HI
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Zip | 96816-2213
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Country | US
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Telephone | 808-372-2477
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN-OWNER
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Name | DR. JASMINE WAIPA
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Credential | MD
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Telephone | 808-372-2477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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