Provider Demographics
NPI:1326481409
Name:THEOS, KIMBERLY R (DO)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:R
Last Name:THEOS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 S KING ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3097
Mailing Address - Country:US
Mailing Address - Phone:808-522-4000
Mailing Address - Fax:808-522-4769
Practice Address - Street 1:888 S KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3097
Practice Address - Country:US
Practice Address - Phone:808-522-4000
Practice Address - Fax:808-522-4769
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS-1729208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI(DOSR-256)OtherMDR