Healthcare Provider Details

I. General information

NPI: 1013667740
Provider Name (Legal Business Name): KALIHI-PALAMA HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N KING ST
HONOLULU HI
96817-4544
US

IV. Provider business mailing address

PO BOX 17460
HONOLULU HI
96817-0460
US

V. Phone/Fax

Practice location:
  • Phone: 808-843-7263
  • Fax:
Mailing address:
  • Phone: 808-848-1438
  • Fax: 808-843-7270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: EMMANUEL KINTU
Title or Position: EXECUTIVE DIRECTOR/CEO
Credential:
Phone: 808-791-6315