Provider Demographics
NPI:1982636064
Name:KERN, KEVIN BRADLEY
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:BRADLEY
Last Name:KERN
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:PO BOX 3270
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96801-3270
Mailing Address - Country:US
Mailing Address - Phone:808-538-3232
Mailing Address - Fax:808-538-3220
Practice Address - Street 1:1360 S BERETANIA ST
Practice Address - Street 2:#215
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1520
Practice Address - Country:US
Practice Address - Phone:808-532-3711
Practice Address - Fax:808-532-3713
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-11418207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
495996-01OtherACS
A013OtherCHAMPUS TRICARE
0000228098OtherHMSA
H53277Medicare ID - Type Unspecified
A013OtherCHAMPUS TRICARE
G76294Medicare UPIN