Healthcare Provider Details

I. General information

NPI: 1750409421
Provider Name (Legal Business Name): KAUAI MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KAUAI MEDICAL CLINIC - ELEELE CLINIC 4382 WAIALO RD
ELEELE HI
96705
US

IV. Provider business mailing address

1946 YOUNG ST SUITE 320
HONOLULU HI
96826-2169
US

V. Phone/Fax

Practice location:
  • Phone: 808-335-0499
  • Fax: 808-335-0496
Mailing address:
  • Phone: 808-973-7320
  • Fax: 808-973-7325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID OKABE
Title or Position: CFO, SR. VICE PRESIDENT
Credential:
Phone: 808-535-7202