Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 30001 | IA |
N | 208000000X | Pediatrician | 30001 | IA |
NPI | 1174518955 |
---|---|
Provider Name | Dr. Adam B Kanis |
First Address | Tamc, HI 96859-5001 |
Second Address | Tamc, HI 96859-5001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2005 |
Last Update Date | 10/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0116129 | (05) | IA |
17019 | WELLMARK BCBS (01) | IA |
F85811 | (02) | |
VAD000 | (02) |