Healthcare Provider Details

I. General information

NPI: 1952445009
Provider Name (Legal Business Name): HALEIWA FAMILY CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66-125 KAMEHAMEHA HWY
HALEIWA HI
96712-1420
US

IV. Provider business mailing address

66-125 KAMEHAMEHA HWY
HALEIWA HI
96712-1420
US

V. Phone/Fax

Practice location:
  • Phone: 808-637-5087
  • Fax: 808-637-4765
Mailing address:
  • Phone: 808-637-5087
  • Fax: 808-637-4765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateHI

VIII. Authorized Official

Name: DR. RANDALL SUZUKA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 808-637-5087