Provider Demographics
NPI:1467400770
Name:KOCIVAR, JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:KOCIVAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1883 MILL ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1248
Mailing Address - Country:US
Mailing Address - Phone:808-244-7032
Mailing Address - Fax:808-242-0801
Practice Address - Street 1:1883 MILL ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1248
Practice Address - Country:US
Practice Address - Phone:808-244-7032
Practice Address - Fax:808-242-0801
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4752174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01317701Medicaid
HI01317701Medicaid
HIA64212Medicare UPIN