KYLE JAMES PEDERSON
NPI 1740957158
Military Health Care Provider - Independent Duty Corpsman in Kailua, HI

Q: What is Kyle Pederson's NPI number?

The NPI number for Kyle Pederson is 1740957158. It was assigned to this individual provider in the NPPES registry on August 24, 2021.

Q: What is Kyle Pederson's specialty?

The primary specialty registered for this NPI is Military Health Care Provider, specializing in Independent Duty Corpsman, with taxonomy code 1710I1002X.

Q: When was this NPI record last updated?

The NPPES record for Kyle Pederson was last updated on April 14, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since August 24, 2021

6905 HARRIS AVE, KAILUA, HI 96734(808) 257-3365 Get Directions Write a Review

NPPES record last updated: April 14, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Apr 14, 2022, Aug 24, 2021 (2 updates tracked since 2021).

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About Kyle James Pederson NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KYLE JAMES PEDERSON (NPI 1740957158) is an individual independent duty corpsman provider in Kailua, Hawaii and active in the NPI registry since August 2021. He maintains a secondary practice location in San Diego.

NPPES Registry Identity

NPI1740957158

Entity TypeIndividualMale

Primary Taxonomy1710I1002X

Provider Legal NameKYLE JAMES PEDERSON

Location Address6905 HARRIS AVEKailua, HI 96734

Mailing AddressMag-24 Mwss, Mcbh Box 63047Mcbh Kaneohe Bay, HI 96863-3047

Phone(808) 257-3365

Sole ProprietorNo

Enumeration DateAugust 24, 2021

Last NPPES UpdateApril 14, 20222 updates tracked since enumeration

NPPES CertifiedMarch 31, 2022

✔ NPI 1740957158 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyMilitary Health Care Provider · Independent Duty CorpsmanOther Service Providers

Taxonomy Code1710I1002X

Definition

A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

6905 HARRIS AVE, Kailua, HI 96734

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Secondary Practice Location 1

Location 134101 Farenholt Ave Bldg 14San Diego, CA 92134-7000 · Phone (910) 260-7902

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JEREMY FRED RICE ATC

Specialist/Technologist (Athletic Trainer)

6905 HARRIS AVE
KAILUA, HI 96734

Honolulu County (702) 637-5427

DAWN KABRICH WARD D.O.

Family Medicine

6905 HARRIS AVE
KAILUA, HI 96734

Honolulu County (808) 257-3365

JESSICA LOFTON

Physician Assistant

6905 HARRIS AVE
KAILUA, HI 96734

Honolulu County (808) 257-3365

DR. ALEXANDER STANTON JAHNCKE MD

General Practice

6905 HARRIS AVE
KAILUA, HI 96734

Honolulu County (808) 257-3100

KEEGAN PATRICK FEES PA-C

Physician Assistant

6905 HARRIS AVE
MCBH KANEOHE BAY, HI 96734

Honolulu County (808) 473-7551

STEPHANIE LYNNE AMICK PA-C

Physician Assistant

6905 HARRIS AVE
KAILUA, HI 96734

Honolulu County (808) 257-3365

GIACOMO TOMASELLO

Family Medicine

6905 HARRIS AVE
KAILUA, HI 96734

Honolulu County (808) 257-2837

BRIAN JOSHUA ROSS

Physician Assistant

6905 HARRIS AVE
KAILUA, HI 96734

Honolulu County (808) 257-3365

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kyle Pederson's NPI number?

The NPI number for Kyle Pederson is 1740957158. It was assigned to this individual provider in the NPPES registry on August 24, 2021.

Where is Kyle Pederson located?

Kyle Pederson practices at 6905 Harris Ave, Kailua, HI 96734. The listed phone number is (808) 257-3365.

What is Kyle Pederson's specialty?

The primary specialty registered for this NPI is Military Health Care Provider, specializing in Independent Duty Corpsman, with taxonomy code 1710I1002X.

When was this NPI record last updated?

The NPPES record for Kyle Pederson was last updated on April 14, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.