=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972583011
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN N KON MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2006
-----------------------------------------------------
Last Update Date | 07/12/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1319 PUNAHOU ST
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-983-8626
-----------------------------------------------------
Fax | 808-983-8710
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 941 KAMEHAMEHA HWY STE 208
-----------------------------------------------------
City | PEARL CITY
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96782-2516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-454-5200
-----------------------------------------------------
Fax | 808-454-5201
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085P0229X
-----------------------------------------------------
Taxonomy Name | Pediatric Radiology Physician
-----------------------------------------------------
License Number | MD10491
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------