Basic Information
| Provider Information | |||||||||
| NPI: | 1619198710 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERNANDEZ | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | KAWAILOA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 701446 | ||||||||
| Address2: | |||||||||
| City: | KAPOLEI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967091446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082064333 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1319 PUNAHOU ST | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968261001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089836000 | ||||||||
| FaxNumber: | 8089836109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 12/17/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD-13976 | HI | Y | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | MD-13976 | HI | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0933136 | 01 | HI | UHA PIN FOR KMCWC | OTHER | 59930002 | 01 | HI | MEDICAID PIN FOR KMCWC | OTHER | H102846 | 01 | HI | MEDICARE PIN FOR KMS | OTHER | H102847 | 01 | HI | MEDICARE PIN FOR KMCWC | OTHER | 0933137 | 01 | HI | UHA PIN FOR KMS | OTHER | 59930001 | 01 | HI | MEDICAID PIN FOR KMS | OTHER | 0000269027 | 01 | HI | HMSA PIN FOR KMCWC | OTHER | 00A0269025 | 01 | HI | HMSA PIN FOR KMS | OTHER |