Provider Demographics
NPI:1275949703
Name:KAUKILA PONO
Entity Type:Organization
Organization Name:KAUKILA PONO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COON
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSHA
Authorized Official - Phone:808-635-4570
Mailing Address - Street 1:3-2600 KAUMUALII HWY
Mailing Address - Street 2:SUITE 1300 PMB 477
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-2040
Mailing Address - Country:US
Mailing Address - Phone:808-635-4570
Mailing Address - Fax:
Practice Address - Street 1:5806 LOKELANI RD
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-9758
Practice Address - Country:US
Practice Address - Phone:808-635-4570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-04
Last Update Date:2014-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
HI35316251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care