MEDICARE: DR. HAKU KEVIN KAHOANO M.D.

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	207R00000X	Internal Medicine Physician	MD-14815	HI
2	208D00000X	General Practice Physician	MD-14815	HI
3	207QA0505X	Adult Medicine Physician	MD-14815	HI

General Provider Information

NPI Number	:	1073714937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAKU KEVIN KAHOANO M.D.

Provider Business Mailing Address
First Line	:	201 HIGHLAND RIDGE DR
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66503-2428
Country	:	US
Telephone Number	:	714-916-5156
Fax Number	:

Provider Business Practice Location Address
First Line	:	18144 SECO ST
Second Line	:	MATHIESEN MEMORIAL HEALTH CLINIC
City	:	JAMESTOWN
State	:	CA
Zip	:	95327-9737
Country	:	US
Telephone Number	:	209-984-4824
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	05/18/2015

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