Healthcare Provider Details

I. General information

NPI: 1528884657
Provider Name (Legal Business Name): KUA MANA'O KOKUA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 HOOHUA STREET
HILO HI
96720
US

IV. Provider business mailing address

99 HOOHUA STREET
HILO HI
96720
US

V. Phone/Fax

Practice location:
  • Phone: 808-491-5953
  • Fax:
Mailing address:
  • Phone: 808-491-5953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: APRIL ANN SHINTANI KUA
Title or Position: MEMBER/ORGANIZER
Credential: APRN, FNP, CARN-AP
Phone: 808-491-5953