Individual
KELLIE A FUKUMURA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
35TH MEDICAL GROUP, MISAWA AIR BASE, APO, WA 96319
(808) 779-1513
Mailing address
277 OHUA AVE, HONOLULU, HI 96815-3643
(808) 922-4787
(808) 922-4950
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
AMD 160
HI
363A00000X
Physician Assistant
AMD-160
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A0251122
HMSA
HI
01
—
497603-01
ALOHA CARE
HI
05
—
497603-01
—
HI
Enumeration date
11/23/2005
Last updated
07/23/2025
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