Provider Demographics
NPI:1336237916
Name:KRISTOFICH, JOHN P (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:KRISTOFICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:888 S KING ST
Mailing Address - Street 2:STRAUB DEPARTMENT OF CARDIOLOGY
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3009
Mailing Address - Country:US
Mailing Address - Phone:808-522-3558
Mailing Address - Fax:808-522-4065
Practice Address - Street 1:888 S KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3009
Practice Address - Country:US
Practice Address - Phone:808-522-3558
Practice Address - Fax:808-522-4065
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-11723207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000231472OtherHMSA
HI50050401Medicaid
HI9870444OtherUHA
HI54010Medicare ID - Type Unspecified
HI50050401Medicaid