=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720691926
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAHUKU MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2020
-----------------------------------------------------
Last Update Date | 10/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 66-632 KAM HWY # 101
-----------------------------------------------------
City | HALEIWA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96712-1610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-293-9221
-----------------------------------------------------
Fax | 808-293-1574
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 56-117 PUALALEA ST
-----------------------------------------------------
City | KAHUKU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96731-2052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-293-9221
-----------------------------------------------------
Fax | 808-293-1574
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF REVENUE CYCLE
-----------------------------------------------------
Name | RACHEL ANN CRISTOBAL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 808-293-6269
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------