Basic Information
Provider Information | |||||||||
NPI: | 1982660346 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | STEVENSON | ||||||||
FirstName: | KEVIN | ||||||||
MiddleName: | M | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 321 N KUAKINI ST | ||||||||
Address2: | SUITE 405 | ||||||||
City: | HONOLULU | ||||||||
State: | HI | ||||||||
PostalCode: | 968172364 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8085220190 | ||||||||
FaxNumber: | 8085239068 | ||||||||
Practice Location | |||||||||
Address1: | 347 N KUAKINI ST | ||||||||
Address2: |   | ||||||||
City: | HONOLULU | ||||||||
State: | HI | ||||||||
PostalCode: | 968172306 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8085220190 | ||||||||
FaxNumber: | 8085239068 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/25/2006 | ||||||||
LastUpdateDate: | 10/28/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD12846 | HI | Y |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
ID | Type | State | Issuer | Description | 00A0246627 | 01 | HI | HMSA | OTHER | 550211-02 | 01 | HI | ST DEPT OF PUB SAFETY | OTHER | P00173080 | 01 | HI | PALMETTO GBA | OTHER | 108-2145098 | 01 | HI | AETNA | OTHER | 201243800 | 01 | HI | US LABOR DEPT | OTHER | 508528 | 01 | HI | HI ELEC | OTHER | 550211-01 | 01 | HI | ST DEPT OF PUB SAFETY | OTHER | 0055021101 | 05 | HI |   | MEDICAID | 0055021102 | 05 | HI |   | MEDICAID | 990157698 | 01 | HI | AETNA, UHC, CIGNA | OTHER | 990157698-96701-B013 | 01 | HI | TRICARE | OTHER | 7698147 | 01 | HI | UHA | OTHER | 00B0246625 | 01 | HI | HMSA | OTHER | 990157698-96817-B011 | 01 | HI | TRICARE | OTHER | 103802483 | 01 | HI | US MARSHALL SVC-FED DET C | OTHER | MD12846 | 01 | HI | QUEENS HEALTHCARE | OTHER |