Organization
KENNY R. MALOTT M.D. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRI M MUSCARELLA (BILLER)
(808) 875-7546
Entity
Organization
Contact information
Practice address
375 HUKU LII PL STE 201, KIHEI, HI 96753-8996
(808) 875-7546
(808) 879-4585
Mailing address
375 HUKU LII PL STE 201, KIHEI, HI 96753-8996
(808) 875-7546
(808) 879-4585
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07102601
—
HI
Enumeration date
11/28/2018
Last updated
11/28/2018
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