Healthcare Provider Details

I. General information

NPI: 1063668473
Provider Name (Legal Business Name): WAIKIKI HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 KEONIANA ST
HONOLULU HI
96815-2018
US

IV. Provider business mailing address

277 OHUA AVE
HONOLULU HI
96815-6612
US

V. Phone/Fax

Practice location:
  • Phone: 808-942-5858
  • Fax: 808-942-9633
Mailing address:
  • Phone: 808-791-9355
  • Fax: 808-697-6849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: SHEILA BECKHAM
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: RD, MPH
Phone: 808-791-9302