Provider Demographics
NPI:1821204496
Name:ARCHBOLD, KIM STEWART (DO)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:STEWART
Last Name:ARCHBOLD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55-520 KULANUI ST
Mailing Address - Street 2:BYU-H BOX 1916
Mailing Address - City:LAIE
Mailing Address - State:HI
Mailing Address - Zip Code:96762
Mailing Address - Country:US
Mailing Address - Phone:808-756-7656
Mailing Address - Fax:
Practice Address - Street 1:55 520 KULANUI ST
Practice Address - Street 2:BYU-H BOX 1916
Practice Address - City:LAIE
Practice Address - State:HI
Practice Address - Zip Code:96762
Practice Address - Country:US
Practice Address - Phone:808-293-3210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS1005208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery