Healthcare Provider Details

I. General information

NPI: 1073714937
Provider Name (Legal Business Name): HAKU KEVIN KAHOANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18144 SECO ST MATHIESEN MEMORIAL HEALTH CLINIC
JAMESTOWN CA
95327-9737
US

IV. Provider business mailing address

201 HIGHLAND RIDGE DR
MANHATTAN KS
66503-2428
US

V. Phone/Fax

Practice location:
  • Phone: 209-984-4824
  • Fax:
Mailing address:
  • Phone: 714-916-5156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMD-14815
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-14815
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD-14815
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: