Provider Demographics
NPI:1164864435
Name:CHERYL L LEIALOHA M D INC
Entity Type:Organization
Organization Name:CHERYL L LEIALOHA M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEIALOHA
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:808-947-5606
Mailing Address - Street 1:1319 PUNAHOU ST
Mailing Address - Street 2:SUITE 760
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1001
Mailing Address - Country:US
Mailing Address - Phone:808-947-5606
Mailing Address - Fax:808-947-5805
Practice Address - Street 1:1319 PUNAHOU ST
Practice Address - Street 2:SUITE 760
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1001
Practice Address - Country:US
Practice Address - Phone:808-947-5606
Practice Address - Fax:808-947-5805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-26
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD8857174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI002379-01Medicaid
HI002379-01Medicaid