Provider Demographics
NPI:1811959414
Name:DAWSON, KEVIN L (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:L
Last Name:DAWSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 LUSITANA ST
Mailing Address - Street 2:STE 412
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:808-599-3780
Mailing Address - Fax:808-538-1672
Practice Address - Street 1:1380 LUSITANA ST
Practice Address - Street 2:STE 412
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-599-3780
Practice Address - Fax:808-538-1672
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD12990207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI55567501Medicaid
HI00B0247375OtherHMSA
I10531Medicare UPIN
HIH57348Medicare ID - Type Unspecified