Provider Demographics
NPI:1336437797
Name:IVEY, JON SIMON (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:SIMON
Last Name:IVEY
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:ATTN: LOCKBOX 5799
Mailing Address - Street 2:PO BOX 31000
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96849-5799
Mailing Address - Country:US
Mailing Address - Phone:808-877-7710
Mailing Address - Fax:808-877-7480
Practice Address - Street 1:411 HUKU LII PL STE 303
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7062
Practice Address - Country:US
Practice Address - Phone:808-877-7710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD20823208200000X, 2082S0105X
FLME140512208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand