Provider Demographics
NPI:1972252526
Name:KIDS THRIVE PEDIATRICS, LLC
Entity Type:Organization
Organization Name:KIDS THRIVE PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:LAYUGAN
Authorized Official - Last Name:SHANER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-545-3567
Mailing Address - Street 1:94-1024 HOAINAU ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3272
Mailing Address - Country:US
Mailing Address - Phone:808-349-6128
Mailing Address - Fax:
Practice Address - Street 1:1520 LILIHA ST STE 404
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3563
Practice Address - Country:US
Practice Address - Phone:808-545-3567
Practice Address - Fax:808-545-3568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service