Provider Demographics
NPI:1609159763
Name:LAU, KERRY A (PA)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:A
Last Name:LAU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 PONAHAWAI ST STE 214
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-7830
Mailing Address - Country:US
Mailing Address - Phone:808-969-3331
Mailing Address - Fax:808-935-6175
Practice Address - Street 1:670 PONAHAWAI ST STE 214
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-7830
Practice Address - Country:US
Practice Address - Phone:808-969-3331
Practice Address - Fax:808-935-6175
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00260300363AS0400X
HIAMD502207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical