Basic Information
| Provider Information | |||||||||
| NPI: | 1902897085 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAYES | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1300 | ||||||||
| Address2: | MAIL CODE 61059 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968071300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8088776402 | ||||||||
| FaxNumber: | 8085715587 | ||||||||
| Practice Location | |||||||||
| Address1: | 425 KOLOA ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | KAHULUI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967322486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8088776402 | ||||||||
| FaxNumber: | 8085715587 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2005 | ||||||||
| LastUpdateDate: | 05/13/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 13981 | HI | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 59313802 | 05 | HI | MEDICAID |