MEDICARE: IKE PONO CASE MANAGEMENT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1043165129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IKE PONO CASE MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	PO BOX 10
Second Line	:
City	:	HAUULA
State	:	HI
Zip	:	96717-0010
Country	:	US
Telephone Number	:	808-397-4638
Fax Number	:

Provider Business Practice Location Address
First Line	:	46-208 KAHUHIPA ST STE 101
Second Line	:
City	:	KANEOHE
State	:	HI
Zip	:	96744-3905
Country	:	US
Telephone Number	:	808-397-4638
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	KIMBERLY FANENE
Credential	:	CM
Telephone Number	:	808-397-4638

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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