Healthcare Provider Details

I. General information

NPI: 1821347717
Provider Name (Legal Business Name): KALINO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PUNCHBOWL STREET
HONOLULU HI
96813
US

IV. Provider business mailing address

820 MILILANI STREET SUITE 702A
HONOLULU HI
96813
US

V. Phone/Fax

Practice location:
  • Phone: 808-523-9363
  • Fax: 808-523-9418
Mailing address:
  • Phone: 808-523-9363
  • Fax: 808-523-9418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateHI

VIII. Authorized Official

Name: LAWRENCE BURGESS
Title or Position: MEMBER
Credential: MD
Phone: 808-523-9363