Basic Information
| Provider Information | |||||||||
| NPI: | 1871611558 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KAUAI MEDICAL CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1946 YOUNG ST | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968262169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089737320 | ||||||||
| FaxNumber: | 8089737325 | ||||||||
| Practice Location | |||||||||
| Address1: | KAUAI MEDICAL CLINIC - KOLOA CLINIC | ||||||||
| Address2: | 5371 KOLOA RD | ||||||||
| City: | KOLOA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8087421621 | ||||||||
| FaxNumber: | 8087421592 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 04/27/2011 | ||||||||
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| AuthorizedOfficialLastName: | OKABE | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO, SR. VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8085357202 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | KAUAI MEDICAL CLINIC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.