Provider Demographics
NPI:1619198710
Name:FERNANDEZ, KRISTIN KAWAILOA (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:KAWAILOA
Last Name:FERNANDEZ
Suffix:
Gender:F
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:PO BOX 701446
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96709-1446
Mailing Address - Country:US
Mailing Address - Phone:808-206-4333
Mailing Address - Fax:
Practice Address - Street 1:1319 PUNAHOU ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1001
Practice Address - Country:US
Practice Address - Phone:808-983-6000
Practice Address - Fax:808-983-6109
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-13976208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0933136OtherUHA PIN FOR KMCWC
HI59930002OtherMEDICAID PIN FOR KMCWC
HIH102846OtherMEDICARE PIN FOR KMS
HIH102847OtherMEDICARE PIN FOR KMCWC
HI0933137OtherUHA PIN FOR KMS
HI59930001OtherMEDICAID PIN FOR KMS
HI0000269027OtherHMSA PIN FOR KMCWC
HI00A0269025OtherHMSA PIN FOR KMS