Healthcare Provider Details

I. General information

NPI: 1316600588
Provider Name (Legal Business Name): KOA LABORATORY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 FARRINGTON HWY BLDG 2
KAPOLEI HI
96707-2028
US

IV. Provider business mailing address

599 FARRINGTON HWY BLDG 2
KAPOLEI HI
96707-2028
US

V. Phone/Fax

Practice location:
  • Phone: 808-693-8807
  • Fax: 808-674-4123
Mailing address:
  • Phone: 808-693-8807
  • Fax: 808-674-4123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JENNALYN BISHOP
Title or Position: CHIEF MEDICAL LABORATORY SCIENTIST
Credential: MLS, TT
Phone: 719-505-5922