Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD11873 | HI |
N | 207QS0010X | Family Doctor - Sports Medicine | MD11873 | HI |
NPI | 1326028416 |
---|---|
Provider Name | Dr. Kazu Hernandez |
First Address | Tripler Army Medical Center, HI 96859-5001 |
Second Address | Tripler Amc, HI 96859-5001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2006 |
Last Update Date | 24/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD000 | (02) |