Provider Demographics
NPI:1801856703
Name:CHRISTENSEN, KEVIN PETER (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:PETER
Last Name:CHRISTENSEN
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 1:1380 LUSITANA ST
Mailing Address - Street 2:SUITE 905
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2449
Mailing Address - Country:US
Mailing Address - Phone:808-522-9633
Mailing Address - Fax:808-522-9646
Practice Address - Street 1:1380 LUSITANA ST
Practice Address - Street 2:SUITE 905
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2449
Practice Address - Country:US
Practice Address - Phone:808-522-9633
Practice Address - Fax:808-522-9646
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4914207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118579502Medicaid
D75184Medicare UPIN
TX118579502Medicaid