Provider Demographics
NPI:1194885582
Name:DAWSON DERMATOLOGY, LLC
Entity type:Organization
Organization Name:DAWSON DERMATOLOGY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-599-3780
Mailing Address - Street 1:1380 LUSITANA ST
Mailing Address - Street 2:SUITE 412
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2421
Mailing Address - Country:US
Mailing Address - Phone:808-599-3780
Mailing Address - Fax:808-538-1672
Practice Address - Street 1:1380 LUSITANA ST
Practice Address - Street 2:SUITE 412
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2421
Practice Address - Country:US
Practice Address - Phone:808-599-3780
Practice Address - Fax:808-538-1672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD1577174400000X
HIMD12990174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI12D0620093OtherCLIA NUMBER
HI00B0247375OtherHMSA PROV # - K DAWSON
HI5533560Medicaid
HI00C0034110OtherHMSA PROV # - A IZUMI
HI00B0247375OtherHMSA PROV # - K DAWSON
HI00C0034110OtherHMSA PROV # - A IZUMI
HI12D0620093OtherCLIA NUMBER