Provider Demographics
NPI:1366011256
Name:KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES
Entity Type:Organization
Organization Name:KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:DERAUF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-791-9400
Mailing Address - Street 1:2239 N SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-2539
Mailing Address - Country:US
Mailing Address - Phone:808-791-9400
Mailing Address - Fax:
Practice Address - Street 1:2229 N SCHOOL ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-2588
Practice Address - Country:US
Practice Address - Phone:808-791-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy