Provider Demographics
NPI:1639229008
Name:KAILUA DERMATOLOGY & ASSOCIATES LTD
Entity Type:Organization
Organization Name:KAILUA DERMATOLOGY & ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HELLREICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-261-6133
Mailing Address - Street 1:40 AULIKE ST
Mailing Address - Street 2:SUITE 311
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2758
Mailing Address - Country:US
Mailing Address - Phone:808-261-6133
Mailing Address - Fax:808-262-9222
Practice Address - Street 1:40 AULIKE ST
Practice Address - Street 2:SUITE 311
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2758
Practice Address - Country:US
Practice Address - Phone:808-261-6133
Practice Address - Fax:808-262-9222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2088207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIX34632OtherHMSA BCBS
HI03119501Medicaid
HI191661OtherHIEL
HIA3463 5OtherHMSA HMO KANEOHE
HIMD2088OtherQHCP MDX
HIMD2088 02OtherQHCP MDX
HIMD2088 02OtherQHCP MDX
HI=========OtherPARTICPATING INS
HIA3463 5OtherHMSA HMO KANEOHE