Provider Demographics
NPI:1720080799
Name:CARPENTER, DEE-ANN LEIALOHA (MD)
Entity Type:Individual
Prefix:MS
First Name:DEE-ANN
Middle Name:LEIALOHA
Last Name:CARPENTER
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.
Mailing Address - Street 2:STE. 300
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:808-686-4620
Mailing Address - Fax:808-686-2125
Practice Address - Street 1:550 S. BERETANIA ST.
Practice Address - Street 2:STE. 300
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-686-4620
Practice Address - Fax:808-686-2125
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-9483207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00209301Medicaid
HI000J212496OtherHMSA
HI00209301Medicaid
HI50614Medicare ID - Type Unspecified