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General NPI Number Information
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NPI Number | 1689056699
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Entity Type | Organization
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Legal Business Name | KE OLA PONO OHANA FAMILY MEDICINE CLINIC, LLC
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Dates
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Enumeration Date | 06/25/2015
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Last Update Date | 08/17/2015
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Provider Practice Location Address
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Address Line | 99-128 AIEA HEIGHTS DR SUITE 505
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City | AIEA
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State | HI
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Zip | 96701-3925
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Country | US
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Telephone | 808-536-0300
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Fax | 808-536-0320
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Provider Business Mailing Address
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Address Line | 848 S BERETANIA ST SUITE 400
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City | HONOLULU
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State | HI
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Zip | 96813-2551
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Country | US
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Telephone | 808-536-0300
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Fax | 808-536-0320
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Authorized Official
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Title or Position | CEO
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Name | DR. MELANIE M PAYANAL
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Credential | M.D.
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Telephone | 808-536-0300
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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 | MD - 18089
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License Number State | HI
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