Healthcare Provider Details

I. General information

NPI: 1932564861
Provider Name (Legal Business Name): KAHALA CLINIC FOR CHILDREN & FAMILY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2015
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 WAIALAE AVE STE 207
HONOLULU HI
96816-5312
US

IV. Provider business mailing address

4211 WAIALAE AVE STE 207
HONOLULU HI
96816-5312
US

V. Phone/Fax

Practice location:
  • Phone: 808-542-7349
  • Fax: 808-732-6433
Mailing address:
  • Phone: 808-542-7349
  • Fax: 808-732-6433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number StateHI

VIII. Authorized Official

Name: DR. JASON R KEIFER
Title or Position: OWNER
Credential: MD
Phone: 808-542-7349