Provider Demographics
NPI:1073714937
Name:KAHOANO, HAKU KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:HAKU
Middle Name:KEVIN
Last Name:KAHOANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 HIGHLAND RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-2428
Mailing Address - Country:US
Mailing Address - Phone:714-916-5156
Mailing Address - Fax:
Practice Address - Street 1:18144 SECO ST
Practice Address - Street 2:MATHIESEN MEMORIAL HEALTH CLINIC
Practice Address - City:JAMESTOWN
Practice Address - State:CA
Practice Address - Zip Code:95327-9737
Practice Address - Country:US
Practice Address - Phone:209-984-4824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-14815207R00000X, 208D00000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000Medicare UPIN