Healthcare Provider Details

I. General information

NPI: 1245430065
Provider Name (Legal Business Name): KAHUKU MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 02/06/2014
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 STREET
KAHUKU HI
96731
US

V. Phone/Fax

Practice location:
  • Phone: 808-293-9221
  • Fax: 808-293-2262
Mailing address:
  • Phone: 808-293-9221
  • Fax: 808-293-1574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. STEPHANY N VAIOLETI
Title or Position: CEO
Credential:
Phone: 808-293-9221