Provider Demographics
NPI:1104564640
Name:KAY, DIANE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:KAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 ILIAINA ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1815
Mailing Address - Country:US
Mailing Address - Phone:217-503-0217
Mailing Address - Fax:
Practice Address - Street 1:720 ILIAINA ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1815
Practice Address - Country:US
Practice Address - Phone:217-503-0217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program