Provider Demographics
NPI:1679684443
Name:LUM, MARK KISTLER (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:KISTLER
Last Name:LUM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1380 LUSITANA ST
Mailing Address - Street 2:SUITE 804
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2421
Mailing Address - Country:US
Mailing Address - Phone:808-524-3020
Mailing Address - Fax:808-524-8163
Practice Address - Street 1:1380 LUSITANA ST
Practice Address - Street 2:SUITE 804
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2421
Practice Address - Country:US
Practice Address - Phone:808-524-3020
Practice Address - Fax:808-524-8163
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-02-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HI4873207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIF99831Medicare UPIN
99-0181449Medicare ID - Type Unspecified