MEDICARE: DR. KENNETH ALAN HIRSCH MD, PHD

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
1	174400000X	Specialist	G75716	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G75716	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1871591362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH ALAN HIRSCH MD, PHD

Provider Business Mailing Address
First Line	:	2180 HALAKAU ST
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96821-2604
Country	:	US
Telephone Number	:	808-473-1880
Fax Number	:	808-473-2144

Provider Business Practice Location Address
First Line	:	NAVAL HEALTH CLINIC PEARL HARBOR
Second Line	:
City	:	PEARL HARBOR
State	:	HI
Zip	:	96860
Country	:	US
Telephone Number	:	808-473-1880
Fax Number	:	808-473-2144

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	07/08/2007

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