Provider Demographics
NPI:1154632578
Name:MEDEIROS, KAPUA K (MD)
Entity Type:Individual
Prefix:DR
First Name:KAPUA
Middle Name:K
Last Name:MEDEIROS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAPUA
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4366 KUKUI GROVE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-2006
Mailing Address - Country:US
Mailing Address - Phone:808-246-5600
Mailing Address - Fax:
Practice Address - Street 1:4366 KUKUI GROVE ST STE 101
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-2006
Practice Address - Country:US
Practice Address - Phone:808-246-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI17044207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine