Provider Demographics
NPI:1275987679
Name:MALAMA NA KEIKI O KAUAI, LLC
Entity Type:Organization
Organization Name:MALAMA NA KEIKI O KAUAI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:RAELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-645-1286
Mailing Address - Street 1:PO BOX 929
Mailing Address - Street 2:
Mailing Address - City:KALAHEO
Mailing Address - State:HI
Mailing Address - Zip Code:96741-0929
Mailing Address - Country:US
Mailing Address - Phone:808-645-1286
Mailing Address - Fax:
Practice Address - Street 1:2469 PUU RD STE C
Practice Address - Street 2:
Practice Address - City:KALAHEO
Practice Address - State:HI
Practice Address - Zip Code:96741-8509
Practice Address - Country:US
Practice Address - Phone:808-645-1286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI13598261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care