Provider Demographics
NPI:1225163108
Name:KUMAR, KRISHNA (MD)
Entity Type:Individual
Prefix:
First Name:KRISHNA
Middle Name:
Last Name:KUMAR
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 1:4100 ONI PL
Mailing Address - Street 2:
Mailing Address - City:KALAHEO
Mailing Address - State:HI
Mailing Address - Zip Code:96741-9568
Mailing Address - Country:US
Mailing Address - Phone:808-332-8433
Mailing Address - Fax:
Practice Address - Street 1:4100 ONI PL
Practice Address - Street 2:
Practice Address - City:KALAHEO
Practice Address - State:HI
Practice Address - Zip Code:96741-9568
Practice Address - Country:US
Practice Address - Phone:808-332-8433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI25732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
99-225582OtherFEDERAL ID
HI03518802Medicaid
HIA38875OtherFOR HMSA
HID43580Medicare UPIN
HI03518802Medicaid