Provider Demographics
NPI:1831127372
Name:CHRISTENSON, EDWARD B
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:B
Last Name:CHRISTENSON
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 1:934 MAUNAWILI CIR
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4619
Mailing Address - Country:US
Mailing Address - Phone:808-261-7801
Mailing Address - Fax:808-261-7725
Practice Address - Street 1:934 MAUNAWILI CIR
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4619
Practice Address - Country:US
Practice Address - Phone:808-261-7801
Practice Address - Fax:808-261-7725
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-12303207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
549199-01OtherACS
A011OtherTRICARE
835014OtherUHA
0000246207OtherHMSA
835014OtherUHA
0000246207OtherHMSA