Healthcare Provider Details

I. General information

NPI: 1376596643
Provider Name (Legal Business Name): KAUAI MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3-3420 KUHIO HWY SUITE B
LIHUE HI
96766-1098
US

IV. Provider business mailing address

1946 YOUNG ST SUITE 320
HONOLULU HI
96826-2169
US

V. Phone/Fax

Practice location:
  • Phone: 808-245-1500
  • Fax: 808-246-1625
Mailing address:
  • Phone: 808-973-7320
  • Fax: 808-973-7325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID OKABE
Title or Position: CFO, SR. VICE PRESIDENT
Credential:
Phone: 808-535-7202