Healthcare Provider Details

I. General information

NPI: 1730360934
Provider Name (Legal Business Name): KAHUKU MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 01/30/2014
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 ST
KAHUKU HI
96731-2052
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 TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHY-699
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberPHY-699
License Number StateHI

VIII. Authorized Official

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