Provider Demographics
NPI:1003904921
Name:SARUWATARI, KENN (MD)
Entity Type:Individual
Prefix:DR
First Name:KENN
Middle Name:
Last Name:SARUWATARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-151 PALI MOMI ST
Mailing Address - Street 2:SUITE 142
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4300
Mailing Address - Country:US
Mailing Address - Phone:808-483-6400
Mailing Address - Fax:808-483-6082
Practice Address - Street 1:98-151 PALI MOMI ST
Practice Address - Street 2:SUITE 142
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4300
Practice Address - Country:US
Practice Address - Phone:808-483-6400
Practice Address - Fax:808-483-6082
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-4882208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI017841Medicaid
HI0000019174OtherHMSA
HI017841Medicaid
HI53787Medicare ID - Type Unspecified