Provider Demographics
NPI:1588234140
Name:DEACON, KYLE QUIMBY (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:QUIMBY
Last Name:DEACON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:UNIVERSITY OF HAWAII INTERNAL MEDICINE RESIDENCY PROGRA
Mailing Address - Street 2:1356 LUSITANA STREET, 7TH FLOOR STEPHANIE JOHNSON
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF HAWAII INTERNAL MEDICINE RESIDENCY PROGRA
Practice Address - Street 2:1356 LUSITANA STREET, 7TH FLOOR STEPHANIE JOHNSON
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:805-689-4368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMDR-8096207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine