Provider Demographics
NPI:1154342962
Name:MCKINNON, JAMES M (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:MCKINNON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 MAHALANI ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2526
Mailing Address - Country:US
Mailing Address - Phone:808-442-5823
Mailing Address - Fax:808-442-5910
Practice Address - Street 1:221 MAHALANI ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2526
Practice Address - Country:US
Practice Address - Phone:808-244-9056
Practice Address - Fax:808-242-2488
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ371292084P0800X
CAA498892084P0800X
WAMD616632102084P0800X
HIMD-196092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A498893Medicaid
CA00A498890OtherBLUE CROSS/BLUE SHIELD
CA00A498893Medicaid
CAA49889Medicare ID - Type Unspecified