Provider Demographics
NPI:1245767318
Name:KANNAN, ASHOK (DO)
Entity Type:Individual
Prefix:
First Name:ASHOK
Middle Name:
Last Name:KANNAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 510083
Mailing Address - Street 2:
Mailing Address - City:KEALIA
Mailing Address - State:HI
Mailing Address - Zip Code:96751-0083
Mailing Address - Country:US
Mailing Address - Phone:808-431-5322
Mailing Address - Fax:808-427-6093
Practice Address - Street 1:5409 LAIPO RD
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-2118
Practice Address - Country:US
Practice Address - Phone:808-431-5322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS-2077207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine