Healthcare Provider Details

I. General information

NPI: 1427082445
Provider Name (Legal Business Name): KOOLAU WOMENS HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 ULUKAHIKI ST STE #209
KAILUA HI
96734-4439
US

IV. Provider business mailing address

642 ULUKAHIKI ST STE #209
KAILUA HI
96734-4439
US

V. Phone/Fax

Practice location:
  • Phone: 808-230-8500
  • Fax: 808-230-8500
Mailing address:
  • Phone: 808-230-8500
  • Fax: 808-230-8501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD6989
License Number StateHI

VIII. Authorized Official

Name: ALISON BHATTACHARYYA
Title or Position: OFFICE MANAGER
Credential:
Phone: 808-230-8500