Healthcare Provider Details

I. General information

NPI: 1568655686
Provider Name (Legal Business Name): KE OLA MAMO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N KUAKINI ST STE 807
HONOLULU HI
96817-2395
US

IV. Provider business mailing address

321 N KUAKINI ST STE 308
HONOLULU HI
96817-2360
US

V. Phone/Fax

Practice location:
  • Phone: 808-440-6852
  • Fax:
Mailing address:
  • Phone: 808-440-6852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOELENE LONO
Title or Position: CEO
Credential:
Phone: 808-848-8000