MEDICARE: MKK HEALTHCARE INC

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	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174662878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MKK HEALTHCARE INC

Provider Business Mailing Address
First Line	:	75-170 HUALALAI RD
Second Line	:	SUITE C110
City	:	KAILUA KONA
State	:	HI
Zip	:	96740-1780
Country	:	US
Telephone Number	:	808-329-9211
Fax Number	:	808-329-0009

Provider Business Practice Location Address
First Line	:	75-170 HUALALAI RD
Second Line	:	SUITE C110
City	:	KAILUA KONA
State	:	HI
Zip	:	96740-1780
Country	:	US
Telephone Number	:	808-329-9211
Fax Number	:	808-329-0009

Authorized Official
Title or Position	:	SECRETARY/TREASURER
Name	:	MRS. BARBARA PENN
Credential	:
Telephone Number	:	808-329-9211

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	01/08/2013

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Directions to “MKK HEALTHCARE INC ” Practice Location

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