Provider Demographics
NPI:1831776699
Name:CORNELL, CHRISTOPHER JA (DO, MS, ATC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JA
Last Name:CORNELL
Suffix:
Gender:M
Credentials:DO, MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47-567 ALAWIKI ST
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-4684
Mailing Address - Country:US
Mailing Address - Phone:808-393-3228
Mailing Address - Fax:
Practice Address - Street 1:47-567 ALAWIKI ST
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-4684
Practice Address - Country:US
Practice Address - Phone:727-384-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7812207Q00000X
HIDOS-2325-0208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine