Provider Demographics
NPI:1184754970
Name:KIA, LAVERNE ARABELLA (MD)
Entity type:Individual
Prefix:
First Name:LAVERNE
Middle Name:ARABELLA
Last Name:KIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912139 FORT WEAVER ROAD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706
Mailing Address - Country:US
Mailing Address - Phone:808-671-4530
Mailing Address - Fax:808-676-1066
Practice Address - Street 1:912139 FORT WEAVER ROAD
Practice Address - Street 2:SUITE 209
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706
Practice Address - Country:US
Practice Address - Phone:808-671-4530
Practice Address - Fax:808-676-1066
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD6122207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02864301Medicaid
HI0000BDNZGMedicare ID - Type Unspecified
HI02864301Medicaid