Provider Demographics
NPI:1174662878
Name:MKK HEALTHCARE INC
Entity Type:Organization
Organization Name:MKK HEALTHCARE INC
Other - Org Name:KONA FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-329-9211
Mailing Address - Street 1:75-170 HUALALAI RD
Mailing Address - Street 2:SUITE C110
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1780
Mailing Address - Country:US
Mailing Address - Phone:808-329-9211
Mailing Address - Fax:808-329-0009
Practice Address - Street 1:75-170 HUALALAI RD
Practice Address - Street 2:SUITE C110
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1780
Practice Address - Country:US
Practice Address - Phone:808-329-9211
Practice Address - Fax:808-329-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI05965201Medicaid
HIE58522Medicare UPIN
HIF54555Medicare UPIN
HI54385Medicare ID - Type UnspecifiedDR. BORANIAN
HIH55570Medicare ID - Type UnspecifiedGROUP ID NUMBER
HI05965201Medicaid