Provider Demographics
NPI:1962942003
Name:KEVIN KUROHARA, M.D.
Entity type:Organization
Organization Name:KEVIN KUROHARA, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:KUROHARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-969-3814
Mailing Address - Street 1:75 PUUHONU PL STE 205
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2000
Mailing Address - Country:US
Mailing Address - Phone:808-969-3814
Mailing Address - Fax:808-934-7496
Practice Address - Street 1:75 PUUHONU PL STE 205
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2000
Practice Address - Country:US
Practice Address - Phone:808-969-3814
Practice Address - Fax:808-934-7496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-5812207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HID36161Medicare UPIN