Provider Demographics
NPI:1073619011
Name:OHANA KAUKA, INC.
Entity Type:Organization
Organization Name:OHANA KAUKA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-323-8200
Mailing Address - Street 1:PO BOX 202
Mailing Address - Street 2:
Mailing Address - City:CAPTAIN COOK
Mailing Address - State:HI
Mailing Address - Zip Code:96704-0202
Mailing Address - Country:US
Mailing Address - Phone:808-323-8200
Mailing Address - Fax:808-323-8400
Practice Address - Street 1:82-6123 MAMALAHOA HWY
Practice Address - Street 2:TOP FLOOR
Practice Address - City:CAPTAIN COOK
Practice Address - State:HI
Practice Address - Zip Code:96704-8203
Practice Address - Country:US
Practice Address - Phone:808-323-8200
Practice Address - Fax:808-323-8400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3644261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH56346Medicare PIN