Provider Demographics
NPI:1235432378
Name:INCONTROL DIABETES CENTER, LLC
Entity Type:Organization
Organization Name:INCONTROL DIABETES CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:W K
Authorized Official - Last Name:KAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, CDE
Authorized Official - Phone:808-450-2402
Mailing Address - Street 1:1449 S BERETANIA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1866
Mailing Address - Country:US
Mailing Address - Phone:808-450-2402
Mailing Address - Fax:808-450-2399
Practice Address - Street 1:1449 S BERETANIA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1866
Practice Address - Country:US
Practice Address - Phone:808-450-2402
Practice Address - Fax:808-450-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center