Healthcare Provider Details

I. General information

NPI: 1851529580
Provider Name (Legal Business Name): TRADE WINDS FAMILY MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 N KALAHEO AVE STE. C-306
KAILUA HI
96734-1866
US

IV. Provider business mailing address

970 N KALAHEO AVE STE. C-306
KAILUA HI
96734-1866
US

V. Phone/Fax

Practice location:
  • Phone: 808-263-7383
  • Fax:
Mailing address:
  • Phone: 808-263-7383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberDOS-856
License Number StateHI

VIII. Authorized Official

Name: DR. KIMBERLY KAY MCCAULEY LUND
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 808-372-2420