MEDICARE: KUPUNA MOBILE HEALTH

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	363LA2200X	Adult Health Nurse Practitioner

General Provider Information

NPI Number	:	1083366371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KUPUNA MOBILE HEALTH

Provider Business Mailing Address
First Line	:	PO BOX 831134
Second Line	:
City	:	PEPEEKEO
State	:	HI
Zip	:	96783-1072
Country	:	US
Telephone Number	:	808-359-1641
Fax Number	:	800-884-6702

Provider Business Practice Location Address
First Line	:	28-787 KAUPAKUEA HOMESTEAD RD
Second Line	:
City	:	PEPEEKEO
State	:	HI
Zip	:	96783
Country	:	US
Telephone Number	:	808-359-1641
Fax Number	:	800-884-6702

Authorized Official
Title or Position	:	OWNER
Name	:	GINA PUEN
Credential	:
Telephone Number	:	808-359-1641

Provider Enumeration Date	:	01/19/2022
Last Update Date	:	01/19/2022

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