Provider Demographics
NPI:1144234402
Name:MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:IEE-LIAN
Authorized Official - Last Name:KUO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:808-523-1600
Mailing Address - Street 1:414 ULUNIU ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2517
Mailing Address - Country:US
Mailing Address - Phone:808-261-8345
Mailing Address - Fax:808-262-5239
Practice Address - Street 1:414 ULUNIU ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2517
Practice Address - Country:US
Practice Address - Phone:808-261-8345
Practice Address - Fax:808-262-5239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD12315207K00000X, 207R00000X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH52948Medicare PIN