Provider Demographics
NPI:1538512041
Name:KAILUA EAR, NOSE AND THROAT LLC
Entity Type:Organization
Organization Name:KAILUA EAR, NOSE AND THROAT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-263-5174
Mailing Address - Street 1:642 ULUKAHIKI ST
Mailing Address - Street 2:STE 302
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4400
Mailing Address - Country:US
Mailing Address - Phone:808-263-5174
Mailing Address - Fax:
Practice Address - Street 1:642 ULUKAHIKI ST
Practice Address - Street 2:STE 103
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4400
Practice Address - Country:US
Practice Address - Phone:808-263-5174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI18690174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty