Healthcare Provider Details

I. General information

NPI: 1659393486
Provider Name (Legal Business Name): KALIHI-PALAMA HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 KAAAHI ST
HONOLULU HI
96817-4630
US

IV. Provider business mailing address

915 N KING ST
HONOLULU HI
96817-4544
US

V. Phone/Fax

Practice location:
  • Phone: 808-853-1700
  • Fax: 808-853-2133
Mailing address:
  • Phone: 808-843-7239
  • Fax: 808-841-1265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License NumberW20300018-01
License Number StateHI

VIII. Authorized Official

Name: VICTORIA K LANCASTER
Title or Position: PATIENT ACCOUNTING MANAGER
Credential:
Phone: 808-843-7239