Provider Demographics
NPI:1245007764
Name:COOK, KENIA MARIA (DENTAL HYGIENIST)
Entity type:Individual
Prefix:
First Name:KENIA
Middle Name:MARIA
Last Name:COOK
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 558 BOX 4394
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96375-0044
Mailing Address - Country:US
Mailing Address - Phone:407-719-9863
Mailing Address - Fax:
Practice Address - Street 1:NHC HAWAII 6905 HARRIS AVE
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:808-257-3365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH21071124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist