Provider Demographics
NPI:1134346737
Name:KENNETH T. KAAN, MD., INC
Entity type:Organization
Organization Name:KENNETH T. KAAN, MD., INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:T
Authorized Official - Last Name:KAAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-533-3393
Mailing Address - Street 1:1329 LUSITANA ST STE 206
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2411
Mailing Address - Country:US
Mailing Address - Phone:808-533-3393
Mailing Address - Fax:808-533-1448
Practice Address - Street 1:1329 LUSITANA ST STE 206
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2411
Practice Address - Country:US
Practice Address - Phone:808-533-3393
Practice Address - Fax:808-533-1448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD4194174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02329701Medicaid
HI201436300OtherACS
HIA025856OtherHMSA
HI201436300OtherACS
HI201436300OtherACS