Provider Demographics
NPI:1144202870
Name:KALAUAWA, ELLIOT J (MD)
Entity Type:Individual
Prefix:
First Name:ELLIOT
Middle Name:J
Last Name:KALAUAWA
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 1:277 OHUA AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-6612
Mailing Address - Country:US
Mailing Address - Phone:808-922-4787
Mailing Address - Fax:808-922-4950
Practice Address - Street 1:277 OHUA AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-3643
Practice Address - Country:US
Practice Address - Phone:808-922-4787
Practice Address - Fax:808-922-4950
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 4822207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIJ016095OtherHMSA
HI01501401Medicaid
HI01501401Medicaid
HI01501401Medicaid