Healthcare Provider Details

I. General information

NPI: 1073558417
Provider Name (Legal Business Name): KAHALA URGENT CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 09/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4218 WAIALAE AVE 106A
HONOLULU HI
96816-5321
US

IV. Provider business mailing address

4218 WAIALAE AVE A106
HONOLULU HI
96816-5321
US

V. Phone/Fax

Practice location:
  • Phone: 808-735-0007
  • Fax: 808-735-0021
Mailing address:
  • Phone: 808-735-0007
  • Fax: 808-735-0021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT P RUGGIERI
Title or Position: PRESIDENT
Credential: MD
Phone: 808-735-0007