Basic Information
| Provider Information | |||||||||
| NPI: | 1821032822 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEINZEN JIM | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HEINZEN | ||||||||
| OtherFirstName: | KATE | ||||||||
| OtherMiddleName: | S. | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 1266 | ||||||||
| Address2: | |||||||||
| City: | KAILUA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967341266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082613326 | ||||||||
| FaxNumber: | 8082634604 | ||||||||
| Practice Location | |||||||||
| Address1: | 407 ULUNIU ST | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | KAILUA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967342519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082613326 | ||||||||
| FaxNumber: | 8082634604 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207P00000X | MD - 13731 | HI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0000259358 | 01 | HI | HMSA | OTHER | 579518 | 05 | HI | MEDICAID |