Provider Demographics
NPI:1780979047
Name:GUNAWARDANE, KAMAL JANAKA (MD,MBBS,)
Entity type:Individual
Prefix:
First Name:KAMAL
Middle Name:JANAKA
Last Name:GUNAWARDANE
Suffix:
Gender:M
Credentials:MD,MBBS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-2411
Mailing Address - Country:US
Mailing Address - Phone:808-342-5514
Mailing Address - Fax:
Practice Address - Street 1:95-390 KUAHELANI AVE
Practice Address - Street 2:4 C
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-1192
Practice Address - Country:US
Practice Address - Phone:808-627-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMDR-6084207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine