Provider Demographics
NPI:1659432862
Name:KIRCHNER, KENNETH RAY (PHD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:RAY
Last Name:KIRCHNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77-137 KALANIUKA ST
Mailing Address - Street 2:
Mailing Address - City:HOLUALOA
Mailing Address - State:HI
Mailing Address - Zip Code:96725-9729
Mailing Address - Country:US
Mailing Address - Phone:808-322-2600
Mailing Address - Fax:808-322-2071
Practice Address - Street 1:77-137 KALANIUKA ST
Practice Address - Street 2:
Practice Address - City:HOLUALOA
Practice Address - State:HI
Practice Address - Zip Code:96725-9729
Practice Address - Country:US
Practice Address - Phone:808-322-2600
Practice Address - Fax:808-322-2071
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI710103T00000X
CO474103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R19071Medicare UPIN
HI101439Medicare ID - Type UnspecifiedGROUP
HI101440Medicare ID - Type UnspecifiedINDIV