Provider Demographics
NPI:1932956968
Name:KELLIE WO MD LLC
Entity Type:Organization
Organization Name:KELLIE WO MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-521-6030
Mailing Address - Street 1:1380 LUSITANA ST STE 501
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2441
Mailing Address - Country:US
Mailing Address - Phone:808-521-6030
Mailing Address - Fax:808-521-6273
Practice Address - Street 1:1380 LUSITANA ST STE 501
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2441
Practice Address - Country:US
Practice Address - Phone:808-521-6030
Practice Address - Fax:808-521-6273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty