Provider Demographics
NPI:1639111784
Name:CHING, KEVIN O ROURKE (DPT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:O ROURKE
Last Name:CHING
Suffix:
Gender:M
Credentials:DPT
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 11973
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96828-0973
Mailing Address - Country:US
Mailing Address - Phone:808-597-1555
Mailing Address - Fax:808-597-1596
Practice Address - Street 1:863 HALEKAUWILA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5317
Practice Address - Country:US
Practice Address - Phone:808-597-1555
Practice Address - Fax:808-597-1596
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT24042251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI554213-01Medicaid
HIPT2404OtherSTATE LIS NUMBER
HIPT2404OtherSTATE LIS NUMBER