Healthcare Provider Details

I. General information

NPI: 1780125179
Provider Name (Legal Business Name): KAHUKU MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2017
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56-117 PUALALEA ST
KAHUKU HI
96731-2052
US

IV. Provider business mailing address

56-117 PUALALEA ST
KAHUKU HI
96731-2052
US

V. Phone/Fax

Practice location:
  • Phone: 808-293-6269
  • Fax: 808-293-1574
Mailing address:
  • Phone: 808-293-6269
  • Fax: 808-293-1574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JEROME FLORES
Title or Position: CFO COO
Credential:
Phone: 808-293-6224