Provider Demographics
NPI:1013256072
Name:FOO, DESMOND (MD)
Entity Type:Individual
Prefix:
First Name:DESMOND
Middle Name:
Last Name:FOO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41-1347 KALANIANAOLE HWY
Mailing Address - Street 2:KALO CLINIC
Mailing Address - City:WAIMANALO
Mailing Address - State:HI
Mailing Address - Zip Code:96795-1247
Mailing Address - Country:US
Mailing Address - Phone:808-259-7948
Mailing Address - Fax:808-259-7447
Practice Address - Street 1:41-1347 KALANIANAOLE HWY
Practice Address - Street 2:KALO CLINIC
Practice Address - City:WAIMANALO
Practice Address - State:HI
Practice Address - Zip Code:96795-1247
Practice Address - Country:US
Practice Address - Phone:808-259-7948
Practice Address - Fax:808-259-7447
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
HI18486207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program