Healthcare Provider Details

I. General information

NPI: 1083366371
Provider Name (Legal Business Name): KUPUNA MOBILE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 01/19/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28-787 KAUPAKUEA HOMESTEAD RD
PEPEEKEO HI
96783
US

IV. Provider business mailing address

PO BOX 831134
PEPEEKEO HI
96783-1072
US

V. Phone/Fax

Practice location:
  • Phone: 808-359-1641
  • Fax: 800-884-6702
Mailing address:
  • Phone: 808-359-1641
  • Fax: 800-884-6702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GINA PUEN
Title or Position: OWNER
Credential:
Phone: 808-359-1641