NPIMap

Organization Active NPI

Kenny R. Malott M.D. Inc.

  • Dermatology Physician
  • Kihei, HI
National Provider Identifier
1265902670
Registry record updated Nov 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
KENNY R. MALOTT M.D. INC.
Practice address
375 Huku Lii PL Ste 201
Kihei, HI 96753-8996
Phone
(808) 875-7546
Fax
(808) 879-4585
NPI assigned
Nov 28, 2018
Last updated
Nov 28, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jerri M Muscarella
Title
Biller
Phone
(808) 875-7546

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary
MOHS-Micrographic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0101X
Procedural Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207NS0135X

Addresses

Primary practice location

375 Huku Lii PL Ste 201
Kihei, HI 96753-8996

Mailing address

375 Huku Lii PL Ste 201
Kihei, HI 96753-8996
Phone (808) 875-7546

Other identifiers 1

IdentifierTypeStateIssuer
07102601MedicaidHI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1543363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543363200000",
    "number": "1265902670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 HUKU LII PL STE 201",
            "city": "KIHEI",
            "state": "HI",
            "postal_code": "967538996",
            "telephone_number": "808-875-7546",
            "fax_number": "808-879-4585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 HUKU LII PL STE 201",
            "city": "KIHEI",
            "state": "HI",
            "postal_code": "967538996",
            "telephone_number": "808-875-7546",
            "fax_number": "808-879-4585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNY R. MALOTT M.D. INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-28",
        "last_updated": "2018-11-28",
        "status": "A",
        "authorized_official_last_name": "MUSCARELLA",
        "authorized_official_first_name": "JERRI",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BILLER",
        "authorized_official_telephone_number": "808-875-7546"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07102601",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kihei, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.