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General NPI Number Information
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NPI Number | 1023257524
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Entity Type | Organization
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Legal Business Name | KA WAI OLA FAMILY MEDICAL CLINIC, LLC
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Dates
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Enumeration Date | 02/07/2009
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Last Update Date | 02/07/2009
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Provider Practice Location Address
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Address Line | 94-849 LUMIAINA ST WAIKELE PROFESSIONAL CENTER SUITE #207
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City | WAIPAHU
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State | HI
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Zip | 96797-5025
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Country | US
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Telephone | 808-286-7390
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Fax |
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Provider Business Mailing Address
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Address Line | 94-849 LUMIAINA ST WAIKELE PROFESSIONAL CENTER SUITE #207
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City | WAIPAHU
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State | HI
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Zip | 96797-5025
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Country | US
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Telephone | 808-286-7390
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Fax |
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Authorized Official
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Title or Position | PARTNER/OWNER
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Name | DR. TIMOTHY S. HIURA
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Credential | M.D.
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Telephone | 808-286-7390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD13464
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License Number State | HI
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