Provider Demographics
NPI:1477675478
Name:BOOHER, KENT (MD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:
Last Name:BOOHER
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 1:45-710 KEAAHALA RD
Mailing Address - Street 2:HAWAII STATE HOSPITAL
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3528
Mailing Address - Country:US
Mailing Address - Phone:808-247-2191
Mailing Address - Fax:808-236-8337
Practice Address - Street 1:45-710 KEAAHALA RD
Practice Address - Street 2:HAWAII STATE HOSPITAL
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3528
Practice Address - Country:US
Practice Address - Phone:808-247-2191
Practice Address - Fax:808-236-8337
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-123272084P0800X
HIMD 123272084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry