Provider Demographics
NPI:1548202203
Name:MALOTT, KENNY R (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNY
Middle Name:R
Last Name:MALOTT
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 1:375 HUKU LII PL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8996
Mailing Address - Country:US
Mailing Address - Phone:808-875-7546
Mailing Address - Fax:808-879-4585
Practice Address - Street 1:375 HUKU LII PL
Practice Address - Street 2:SUITE 201
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8996
Practice Address - Country:US
Practice Address - Phone:808-875-7546
Practice Address - Fax:808-879-4585
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD8386207N00000X, 207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Not Answered207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
092353OtherHMSA
HI07102601Medicaid
092353OtherHMSA
F35496Medicare UPIN