Healthcare Provider Details

I. General information

NPI: 1194519264
Provider Name (Legal Business Name): KEKOAHEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2025
Last Update Date: 04/05/2025
Certification Date: 04/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 COBB AVE
PLACENTIA CA
92870-2728
US

IV. Provider business mailing address

802 COBB AVE
PLACENTIA CA
92870-2728
US

V. Phone/Fax

Practice location:
  • Phone: 714-412-8985
  • Fax:
Mailing address:
  • Phone: 714-412-8985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: GEOFFREY KEITH SAMSON
Title or Position: OWNER
Credential: MS, RD
Phone: 714-412-8895