Provider Demographics
NPI:1558543868
Name:KABBUR, PRAKASH MUTTANNA
Entity Type:Individual
Prefix:DR
First Name:PRAKASH
Middle Name:MUTTANNA
Last Name:KABBUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4340 PAHOA AVE
Mailing Address - Street 2:3D
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5044
Mailing Address - Country:US
Mailing Address - Phone:808-291-3162
Mailing Address - Fax:808-983-6392
Practice Address - Street 1:1319 PUNAHOU ST
Practice Address - Street 2:NEONATOLOGY
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1001
Practice Address - Country:US
Practice Address - Phone:808-363-0051
Practice Address - Fax:808-983-6392
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI145582080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine