Healthcare Provider Details

I. General information

NPI: 1073619011
Provider Name (Legal Business Name): OHANA KAUKA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 10/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82-6123 MAMALAHOA HWY TOP FLOOR
CAPTAIN COOK HI
96704-8203
US

IV. Provider business mailing address

PO BOX 202
CAPTAIN COOK HI
96704-0202
US

V. Phone/Fax

Practice location:
  • Phone: 808-323-8200
  • Fax: 808-323-8400
Mailing address:
  • Phone: 808-323-8200
  • Fax: 808-323-8400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number3644
License Number StateHI

VIII. Authorized Official

Name: WILLIAM SCOTT MANDEL
Title or Position: CEO
Credential: M.D.
Phone: 808-323-8200