Provider Demographics
NPI:1679755375
Name:KEVIN P CHRISTENSEN, MD, LLC
Entity type:Organization
Organization Name:KEVIN P CHRISTENSEN, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-522-9633
Mailing Address - Street 1:1329 LUSITANA ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2429
Mailing Address - Country:US
Mailing Address - Phone:808-522-9633
Mailing Address - Fax:808-522-9646
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:SUITE 501
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2429
Practice Address - Country:US
Practice Address - Phone:808-522-9633
Practice Address - Fax:808-522-9646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207X00000X
TXG4914207X00000X
HI13159207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118579502Medicaid
TX118579502Medicaid
D75184Medicare UPIN