Healthcare Provider Details

I. General information

NPI: 1932432820
Provider Name (Legal Business Name): KUPUNARIDE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 09/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 ULUKOU ST
KAILUA HI
96734-4426
US

IV. Provider business mailing address

522 ULUKOU ST
KAILUA HI
96734-4426
US

V. Phone/Fax

Practice location:
  • Phone: 808-262-7433
  • Fax: 888-400-2990
Mailing address:
  • Phone: 808-262-7433
  • Fax: 888-400-2990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JAMES GILLESPIE
Title or Position: PRESIDENT
Credential:
Phone: 808-262-7433