Healthcare Provider Details

I. General information

NPI: 1720190929
Provider Name (Legal Business Name): KAUAI OSTEOPATHIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3483 WELIWELI RD
KOLOA HI
96756-8546
US

IV. Provider business mailing address

3483 WELIWELI RD P.O. BOX 817
KOLOA HI
96756-8546
US

V. Phone/Fax

Practice location:
  • Phone: 808-742-1200
  • Fax: 808-742-1206
Mailing address:
  • Phone: 808-742-1200
  • Fax: 808-742-1206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number918
License Number StateHI

VIII. Authorized Official

Name: LISA CHUN
Title or Position: OWNER/PHYSICIAN
Credential: D.O.
Phone: 808-742-1200