Healthcare Provider Details

I. General information

NPI: 1144854266
Provider Name (Legal Business Name): OHANA IPA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9896 GARDEN GROVE BLVD
GARDEN GROVE CA
92844-1643
US

IV. Provider business mailing address

9896 GARDEN GROVE BLVD
GARDEN GROVE CA
92844-1643
US

V. Phone/Fax

Practice location:
  • Phone: 714-636-3032
  • Fax:
Mailing address:
  • Phone: 714-636-3032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: ROBERT HA
Title or Position: MD/PRESIDENT
Credential: MD
Phone: 714-636-3032