Provider Demographics
NPI:1265460513
Name:BURNES, KEVIN CARPENTER (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:CARPENTER
Last Name:BURNES
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 1:55 AWAKEA LOOP
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8876
Mailing Address - Country:US
Mailing Address - Phone:808-572-2057
Mailing Address - Fax:
Practice Address - Street 1:1360 S BERETANIA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1520
Practice Address - Country:US
Practice Address - Phone:808-532-3711
Practice Address - Fax:808-532-3713
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD13654207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000259309OtherHMSA
HI580812-04Medicaid
HI00A0259307OtherHMSA BILLING NUMBER
H72593Medicare UPIN
HI0000259309OtherHMSA