Provider Demographics
NPI:1033387980
Name:KAUAI DERMATOLOGY LLC
Entity Type:Organization
Organization Name:KAUAI DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CORINA
Authorized Official - Middle Name:E
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-246-6904
Mailing Address - Street 1:4366 KUKUI GROVE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-2006
Mailing Address - Country:US
Mailing Address - Phone:808-246-6904
Mailing Address - Fax:808-246-6081
Practice Address - Street 1:4366 KUKUI GROVE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-2006
Practice Address - Country:US
Practice Address - Phone:808-246-6904
Practice Address - Fax:808-246-6081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty