Healthcare Provider Details

I. General information

NPI: 1144202870
Provider Name (Legal Business Name): ELLIOT J KALAUAWA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 OHUA AVE
HONOLULU HI
96815-3643
US

IV. Provider business mailing address

277 OHUA AVE
HONOLULU HI
96815-6612
US

V. Phone/Fax

Practice location:
  • Phone: 808-922-4787
  • Fax: 808-922-4950
Mailing address:
  • Phone: 808-922-4787
  • Fax: 808-922-4950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD 4822
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: