=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235979659
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAWAII KAI HEALTH CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2024
-----------------------------------------------------
Last Update Date | 08/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6700 KALANIANAOLE HWY STE 106
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96825-1278
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-751-7193
-----------------------------------------------------
Fax | 808-451-2060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6700 KALANIANAOLE HWY STE 106
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96825-1278
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-751-7193
-----------------------------------------------------
Fax | 808-451-2060
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | THOMAS JAMES NORDYKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 808-751-7193
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------