Healthcare Provider Details

I. General information

NPI: 1821335837
Provider Name (Legal Business Name): KO OLAULOA HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2013
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56-490 KAMEHAMEHA HWY ROOM R104
KAHUKU HI
96731-2200
US

IV. Provider business mailing address

PO BOX 395
KAHUKU HI
96731-0395
US

V. Phone/Fax

Practice location:
  • Phone: 808-293-9216
  • Fax: 808-293-5390
Mailing address:
  • Phone: 808-293-9216
  • Fax: 808-293-5390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberCSDT57
License Number StateHI

VIII. Authorized Official

Name: TERRENCE H ARATANI
Title or Position: CEO
Credential:
Phone: 808-792-3840