Provider Demographics
NPI:1639833924
Name:DEBOY, KYLE R
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:R
Last Name:DEBOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-1005 MOANALUA RD SPC 3030
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4735
Mailing Address - Country:US
Mailing Address - Phone:918-804-9085
Mailing Address - Fax:
Practice Address - Street 1:98-1005 MOANALUA RD SPC 3030
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4735
Practice Address - Country:US
Practice Address - Phone:918-804-9085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-24
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOSR-609207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine