Provider Demographics
NPI:1316903610
Name:JENKINS, TYRIE LEE (MD)
Entity type:Individual
Prefix:
First Name:TYRIE
Middle Name:LEE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 31000
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96849-5684
Mailing Address - Country:US
Mailing Address - Phone:808-591-9911
Mailing Address - Fax:808-697-5488
Practice Address - Street 1:615 PIIKOI ST
Practice Address - Street 2:SUITE 205
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3139
Practice Address - Country:US
Practice Address - Phone:808-591-9911
Practice Address - Fax:808-591-9909
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD5046174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI056891-01Medicaid
HIA97978Medicare UPIN
HI056891-01Medicaid