Active NPI
Kevin Wayne Dieffenbach, M.D.
- Plastic Surgery Physician
- Aiea, HI
National Provider Identifier
1861588261
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- License
- 8242
- Practice address
- 98-1247 Kaahumanu St
Suite 109
Aiea, HI 96701-5311 - Phone
- (808) 678-1955
- Fax
- (808) 678-1081
- NPI assigned
- Oct 4, 2006
- Last updated
- Jan 29, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | 8242 | HI | Primary |
Addresses
Primary practice location
98-1247 Kaahumanu St
Suite 109
Aiea, HI 96701-5311
Mailing address
98-1247 Kaahumanu St
Suite 109
Aiea, HI 96701-5311
Phone (808) 678-1955
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Previously, effective Sep 8, 2016 through Sep 8, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8242 | HI | MD | Plastic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1390953600000",
"number": "1861588261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "98-1247 KAAHUMANU ST",
"address_2": "SUITE 109",
"city": "AIEA",
"state": "HI",
"postal_code": "967015311",
"telephone_number": "808-678-1955",
"fax_number": "808-678-1081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "98-1247 KAAHUMANU ST",
"address_2": "SUITE 109",
"city": "AIEA",
"state": "HI",
"postal_code": "967015311",
"telephone_number": "808-678-1955",
"fax_number": "808-678-1081"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIEFFENBACH",
"first_name": "KEVIN",
"middle_name": "WAYNE",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-04",
"last_updated": "2014-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "HI",
"license": "8242",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.