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General NPI Number Information
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NPI Number | 1083366371
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Entity Type | Organization
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Legal Business Name | KUPUNA MOBILE HEALTH
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Dates
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Enumeration Date | 01/19/2022
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 28-787 KAUPAKUEA HOMESTEAD RD
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City | PEPEEKEO
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State | HI
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Zip | 96783
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Country | US
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Telephone | 808-359-1641
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Fax | 800-884-6702
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Provider Business Mailing Address
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Address Line | PO BOX 831134
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City | PEPEEKEO
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State | HI
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Zip | 96783-1072
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Country | US
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Telephone | 808-359-1641
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Fax | 800-884-6702
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Authorized Official
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Title or Position | OWNER
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Name | GINA PUEN
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Credential |
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Telephone | 808-359-1641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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