Provider Demographics
NPI:1063524007
Name:KAN, DARRYL M (MD)
Entity type:Individual
Prefix:
First Name:DARRYL
Middle Name:M
Last Name:KAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1380 LUSITANA ST
Mailing Address - Street 2:SUITE 608
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2421
Mailing Address - Country:US
Mailing Address - Phone:808-536-2261
Mailing Address - Fax:808-538-3957
Practice Address - Street 1:1380 LUSITANA ST
Practice Address - Street 2:SUITE 608
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2421
Practice Address - Country:US
Practice Address - Phone:808-536-2261
Practice Address - Fax:808-538-3957
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HIMD7721207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07195002Medicaid
HIF17752Medicare UPIN
HI51664Medicare PIN