Provider Demographics
NPI:1871917633
Name:VICTORIA, KITTY (MD)
Entity type:Individual
Prefix:
First Name:KITTY
Middle Name:
Last Name:VICTORIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79-1019 HAUKAPILA ST
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-7920
Mailing Address - Country:US
Mailing Address - Phone:808-322-6910
Mailing Address - Fax:
Practice Address - Street 1:79-1019 HAUKAPILA ST
Practice Address - Street 2:
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-7920
Practice Address - Country:US
Practice Address - Phone:347-571-7576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUMTL-2024-010207RH0003X
GUM-2444207RH0003X
HI20971207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty