Provider Demographics
NPI:1568626000
Name:PERRY, KYLE RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:RAY
Last Name:PERRY
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 1:1212 NUUANU AVE APT 3707
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-4040
Mailing Address - Country:US
Mailing Address - Phone:808-631-7732
Mailing Address - Fax:
Practice Address - Street 1:1212 NUUANU AVE APT 3707
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-4040
Practice Address - Country:US
Practice Address - Phone:808-631-7732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301092884207P00000X
HIMD16106207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine