Healthcare Provider Details

I. General information

NPI: 1295646529
Provider Name (Legal Business Name): KAMAKAKOA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45-090 NAMOKU ST
KANEOHE HI
96744-5305
US

IV. Provider business mailing address

91-1360 KARAYAN ST
EWA BEACH HI
96706-1985
US

V. Phone/Fax

Practice location:
  • Phone: 808-554-7652
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: LEINA IJACIC
Title or Position: PRESIDENT/CEO
Credential:
Phone: 808-554-7652