Provider Demographics
NPI:1376787440
Name:SHAW, KURT K (LMT)
Entity Type:Individual
Prefix:MR
First Name:KURT
Middle Name:K
Last Name:SHAW
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 NUUANU AVE APT 1211
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-4025
Mailing Address - Country:US
Mailing Address - Phone:808-341-3552
Mailing Address - Fax:
Practice Address - Street 1:925 BETHEL ST STE 205
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-4307
Practice Address - Country:US
Practice Address - Phone:808-341-3552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI7949174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist