Provider Demographics
NPI:1417738378
Name:MIDANI, KHALIL KYLE (LAC)
Entity Type:Individual
Prefix:
First Name:KHALIL
Middle Name:KYLE
Last Name:MIDANI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67-1185 MAMALAHOA HWY UNIT D104
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8412
Mailing Address - Country:US
Mailing Address - Phone:808-481-8514
Mailing Address - Fax:
Practice Address - Street 1:72-3996 PUUKALA RD.
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-8608
Practice Address - Country:US
Practice Address - Phone:808-481-8514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU-1426171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist