1508191685 NPI number — KELLEN KENJI KAWIKA KASHIWA O.D.

Table of content: KELLEN KENJI KAWIKA KASHIWA O.D. (NPI 1508191685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508191685 NPI number — KELLEN KENJI KAWIKA KASHIWA O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KASHIWA
Provider First Name:
KELLEN
Provider Middle Name:
KENJI KAWIKA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508191685
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1300
Provider Second Line Business Mailing Address:
MAILCODE 61323
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96807-1300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-955-0255
Provider Business Mailing Address Fax Number:
808-955-4155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1620 ALA MOANA BLVD
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96815-1437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-955-0255
Provider Business Practice Location Address Fax Number:
808-955-4155
Provider Enumeration Date:
10/07/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152WL0500X , with the licence number:  OD744 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: OD744 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 689127 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".