Provider Demographics
NPI:1184206799
Name:KEALOHANANI LLC
Entity Type:Organization
Organization Name:KEALOHANANI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOKENANI
Authorized Official - Middle Name:K
Authorized Official - Last Name:SOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:808-557-3540
Mailing Address - Street 1:65-1235A OPELO RD STE 1
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8401
Mailing Address - Country:US
Mailing Address - Phone:808-885-5392
Mailing Address - Fax:808-885-5392
Practice Address - Street 1:65-1235A OPELO RD STE 1
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8401
Practice Address - Country:US
Practice Address - Phone:808-885-5392
Practice Address - Fax:808-885-5392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty