=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659531622
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAUAI COMMUNITY HEALTH ALLIANCE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2008
-----------------------------------------------------
Last Update Date | 06/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2460 OKA ST 101-A
-----------------------------------------------------
City | KILAUEA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96754-5308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-828-2882
-----------------------------------------------------
Fax | 808-828-0119
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2460 OKA ST 101-A
-----------------------------------------------------
City | KILAUEA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96754-5308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-828-2882
-----------------------------------------------------
Fax | 808-828-0119
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DR. STEVE M ROGOFF
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 808-828-2885
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Clinic/Center
-----------------------------------------------------
License Number | 11990
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------