Provider Demographics
NPI:1831315951
Name:LUND, KIMBERLY KAY (DO)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:KAY
Last Name:LUND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 LANIPO DR
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3231
Mailing Address - Country:US
Mailing Address - Phone:808-263-1922
Mailing Address - Fax:
Practice Address - Street 1:970 N KALAHEO AVE
Practice Address - Street 2:SUITE C306
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1866
Practice Address - Country:US
Practice Address - Phone:808-263-7383
Practice Address - Fax:808-237-5828
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS-856207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000254441OtherHMSA
HICH315AOtherMEDICARE PTAN
HI56992301Medicaid