Provider Demographics
NPI:1598763781
Name:KIMATA, KEVIN G (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:G
Last Name:KIMATA
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 1:321 N KUAKINI ST
Mailing Address - Street 2:SUITE 810
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2364
Mailing Address - Country:US
Mailing Address - Phone:808-523-5885
Mailing Address - Fax:808-538-6595
Practice Address - Street 1:321 N KUAKINI ST
Practice Address - Street 2:SUITE 605
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2364
Practice Address - Country:US
Practice Address - Phone:808-523-5886
Practice Address - Fax:808-538-6595
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI98432084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI08860402Medicaid
HI22229-9OtherHMSA/DCBS
HI51159Medicare ID - Type Unspecified
G73187Medicare UPIN