Provider Demographics
| NPI: | 1275566424 |
|---|---|
| Name: | WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INC |
| Entity Type: | Organization |
| Organization Name: | WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INC |
| Other - Org Name: | WAIANAE COAST COMPREHENSIVE HEALTH CENTER |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | CFO |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | JAMES |
| Authorized Official - Middle Name: | Z |
| Authorized Official - Last Name: | CHEN |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MBA, CMPE |
| Authorized Official - Phone: | 808-697-3300 |
| Mailing Address - Street 1: | 86-260 FARRINGTON HWY |
| Mailing Address - Street 2: | |
| Mailing Address - City: | WAIANAE |
| Mailing Address - State: | HI |
| Mailing Address - Zip Code: | 96792-3128 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 808-697-3300 |
| Mailing Address - Fax: | 808-697-3687 |
| Practice Address - Street 1: | 86-260 FARRINGTON HWY |
| Practice Address - Street 2: | |
| Practice Address - City: | WAIANAE |
| Practice Address - State: | HI |
| Practice Address - Zip Code: | 96792-3128 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 808-697-3300 |
| Practice Address - Fax: | 808-697-3687 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-07-09 |
| Last Update Date: | 2022-02-01 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
| No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 2083P0901X | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 2085U0001X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
| No | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| ========= | Other | PAYEE ID | |
| WCCHC70 | Medicare ID - Type Unspecified | MEDICARE PART B GROUP # |
