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NPI Code Detail

MEDICARE: KAHEALANI LANE

MEDICARE: KAHEALANI LANE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant6056SC

General Provider Information

NPI Number : 1689439473
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAHEALANI LANE
Provider Business Mailing Address
First Line : 16 CEDAR DR N
Second Line :
City : SURFSIDE BEACH
State : SC
Zip : 29575-3830
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7410 HIGHWAY 707
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29588-7304
Country : US
Telephone Number : 843-215-1100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2024
Last Update Date : 11/20/2025

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Directions to “ KAHEALANI LANE ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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