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General NPI Number Information
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NPI Number | 1962135509
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Entity Type | Individual
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Provider Name | KYLER JORDAN MASONHEIMER PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/01/2022
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 98-211 PALI MOMI ST STE 312
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City | AIEA
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State | HI
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Zip | 96701-4306
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Country | US
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Telephone | 808-486-0449
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Fax | 808-488-0725
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Provider Business Mailing Address
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Address Line | 98-211 PALI MOMI ST STE 312
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City | AIEA
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State | HI
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Zip | 96701-4306
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Country | US
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Telephone | 808-486-0449
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA15340
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | AMD-1333
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License Number State | HI
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