Provider Demographics
NPI:1194081901
Name:KYLE, KIMBERLY (DO)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:KYLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:KEEFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:91-2141 FORT WEAVER RD
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-1993
Mailing Address - Country:US
Mailing Address - Phone:808-691-3000
Mailing Address - Fax:
Practice Address - Street 1:91-2141 FORT WEAVER RD
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-1993
Practice Address - Country:US
Practice Address - Phone:808-691-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101021661207R00000X
HIDOS-1900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M32310Medicare PIN