Individual
STACY K KANAYAMA-TRIVEDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
480 CENTRAL AVE, DEPARTMENT OF FAMILY MEDICINE, JBPHH, HI 96860-4908
(808) 473-1880
(808) 473-4411
Mailing address
480 CENTRAL AVE, DEPARTMENT OF FAMILY MEDICINE, JBPHH, HI 96860-4908
(808) 473-1880
(808) 473-4411
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
202089
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1092479
—
LA
Enumeration date
05/24/2007
Last updated
05/20/2014
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