Provider Demographics
NPI:1376596643
Name:KAUAI MEDICAL CLINIC
Entity Type:Organization
Organization Name:KAUAI MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO, SR. VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:OKABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-535-7202
Mailing Address - Street 1:1946 YOUNG ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-2169
Mailing Address - Country:US
Mailing Address - Phone:808-973-7320
Mailing Address - Fax:808-973-7325
Practice Address - Street 1:3-3420 KUHIO HWY
Practice Address - Street 2:SUITE B
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1098
Practice Address - Country:US
Practice Address - Phone:808-245-1500
Practice Address - Fax:808-246-1625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIHAUAIMED71Medicare PIN
HIX05819Medicare UPIN