Healthcare Provider Details

I. General information

NPI: 1568690840
Provider Name (Legal Business Name): KU ALOHA OLA MAU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15-1926 PUAKALO (30TH) AVE.
KEAAU HI
96749
US

IV. Provider business mailing address

1130 N NIMITZ HWY C302
HONOLULU HI
96817-4579
US

V. Phone/Fax

Practice location:
  • Phone: 808-982-9555
  • Fax: 808-982-9554
Mailing address:
  • Phone: 808-538-0704
  • Fax: 808-538-0474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateHI

VIII. Authorized Official

Name: LISA COOK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 808-538-0704