Healthcare Provider Details

I. General information

NPI: 1891160172
Provider Name (Legal Business Name): KUAKINI SUPPORT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 N KUAKINI ST
HONOLULU HI
96817-2336
US

IV. Provider business mailing address

347 N KUAKINI ST
HONOLULU HI
96817-2336
US

V. Phone/Fax

Practice location:
  • Phone: 808-547-9231
  • Fax:
Mailing address:
  • Phone: 808-547-9231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GARY KAJIWARA
Title or Position: PRESIDENT & CEO
Credential:
Phone: 808-547-9231