Provider Demographics
NPI:1255475752
Name:KIHEI-WAILEA MEDICAL CENTER. LLC
Entity Type:Organization
Organization Name:KIHEI-WAILEA MEDICAL CENTER. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GINI
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-270-0491
Mailing Address - Street 1:221 PIIKEA AVE # A
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8268
Mailing Address - Country:US
Mailing Address - Phone:808-874-8100
Mailing Address - Fax:808-874-6887
Practice Address - Street 1:221 PIIKEA AVE # A
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8268
Practice Address - Country:US
Practice Address - Phone:808-874-8100
Practice Address - Fax:808-874-6887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI52798Medicare ID - Type Unspecified