Provider Demographics
NPI:1912216599
Name:DAVID A KUCHENBECKER MD, INC
Entity Type:Organization
Organization Name:DAVID A KUCHENBECKER MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:KUCHENBECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-261-4884
Mailing Address - Street 1:PO BOX 1091
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1091
Mailing Address - Country:US
Mailing Address - Phone:808-261-4884
Mailing Address - Fax:808-261-4885
Practice Address - Street 1:30 AULIKE ST STE 602
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2752
Practice Address - Country:US
Practice Address - Phone:808-261-4884
Practice Address - Fax:808-261-4885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI06016902Medicaid
HIMD7248-01OtherQUEENS HEALTHCARE
HIE079946OtherHMSA
HI4150150001Medicare NSC
HIDY714AMedicare PIN