Provider Demographics
NPI:1649618844
Name:KAWAMOTO, KRIS REN (MD)
Entity type:Individual
Prefix:
First Name:KRIS
Middle Name:REN
Last Name:KAWAMOTO
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 1:550 S BERETANIA ST STE 702
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2496
Mailing Address - Country:US
Mailing Address - Phone:808-691-8808
Mailing Address - Fax:808-691-8861
Practice Address - Street 1:550 S BERETANIA ST STE 702
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2496
Practice Address - Country:US
Practice Address - Phone:808-691-8808
Practice Address - Fax:808-691-8861
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-21925207RI0011X
MI4301103408207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine