Provider Demographics
NPI:1578519229
Name:KUROHARA, KEVIN KIYOSHI
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:KIYOSHI
Last Name:KUROHARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 PUUHONU PLACE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720
Mailing Address - Country:US
Mailing Address - Phone:808-969-3814
Mailing Address - Fax:808-934-7496
Practice Address - Street 1:75 PUUHONU PLACE
Practice Address - Street 2:SUITE 205
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720
Practice Address - Country:US
Practice Address - Phone:808-969-3814
Practice Address - Fax:808-934-7496
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5812207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIE26533OtherHMSA
HI02384701Medicaid
HI02384701Medicaid
H0000BDPGBMedicare ID - Type Unspecified