Provider Demographics
NPI:1225534159
Name:IWAHASHI-MARQUEZ, KRISTY KIMI (DPM)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:KIMI
Last Name:IWAHASHI-MARQUEZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-1079 MOANALUA RD
Mailing Address - Street 2:STE 400
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4715
Mailing Address - Country:US
Mailing Address - Phone:808-488-8101
Mailing Address - Fax:
Practice Address - Street 1:98-1079 MOANALUA RD STE 400
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4715
Practice Address - Country:US
Practice Address - Phone:808-488-8101
Practice Address - Fax:808-488-8389
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-31
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
211D00000X, 390200000X
HIPO235213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No211D00000XPodiatric Medicine & Surgery Service ProvidersAssistant, Podiatric
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program