Provider Demographics
NPI:1174747828
Name:HADLEY, KEVIN SHAWN (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:SHAWN
Last Name:HADLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:98-1079 MOANALUA RD STE 310
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4722
Mailing Address - Country:US
Mailing Address - Phone:808-486-3277
Mailing Address - Fax:808-486-0432
Practice Address - Street 1:98-1079 MOANALUA RD STE 310
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4722
Practice Address - Country:US
Practice Address - Phone:808-486-3277
Practice Address - Fax:808-486-0432
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085901207YX0901X
HIMD14172207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology