Provider Demographics
NPI:1184917205
Name:MORTENSEN, KAWIKA ANALU (MD)
Entity type:Individual
Prefix:DR
First Name:KAWIKA
Middle Name:ANALU
Last Name:MORTENSEN
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 1:651 ILALO ST
Mailing Address - Street 2:MEB #401A
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5525
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:651 ILALO ST
Practice Address - Street 2:MEB #401A
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5525
Practice Address - Country:US
Practice Address - Phone:808-692-1131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program