Provider Demographics
NPI:1407856479
Name:PERSKE, KENNETH F (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:F
Last Name:PERSKE
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 1:1319 PUNAHOU ST
Mailing Address - Street 2:#1180
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1001
Mailing Address - Country:US
Mailing Address - Phone:808-955-6324
Mailing Address - Fax:808-955-5741
Practice Address - Street 1:1319 PUNAHOU ST
Practice Address - Street 2:#1180
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1001
Practice Address - Country:US
Practice Address - Phone:808-955-6324
Practice Address - Fax:808-955-5741
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD4595207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01579501Medicaid
C98588Medicare UPIN
HI01579501Medicaid