Healthcare Provider Details

I. General information

NPI: 1134898042
Provider Name (Legal Business Name): WAIKIKI HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 09/13/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 PALOLO AVE
HONOLULU HI
96816-2928
US

IV. Provider business mailing address

277 OHUA AVE
HONOLULU HI
96815-3695
US

V. Phone/Fax

Practice location:
  • Phone: 808-922-4787
  • Fax: 808-922-4950
Mailing address:
  • Phone: 808-537-8418
  • 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: JAMES T MARUYAMA
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 808-537-8418