Provider Demographics
NPI:1497855191
Name:KOGUT, AMY B (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:KOGUT
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 1:1243 LOHO ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3672
Mailing Address - Country:US
Mailing Address - Phone:808-263-3020
Mailing Address - Fax:808-758-0556
Practice Address - Street 1:1243 LOHO ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3672
Practice Address - Country:US
Practice Address - Phone:808-263-3020
Practice Address - Fax:808-758-0556
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-6273207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000035345OtherHMSA BILLING NUMBER
HI031910-01Medicaid
HI031910-01Medicaid
HIH0000BDQBKMedicare PIN