Provider Demographics
NPI:1376842492
Name:KALIHI PALAMA HEALTH CENTER
Entity Type:Organization
Organization Name:KALIHI PALAMA HEALTH CENTER
Other - Org Name:KPHC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KINTU
Authorized Official - Suffix:
Authorized Official - Credentials:DMGT, MBA
Authorized Official - Phone:808-791-6315
Mailing Address - Street 1:PO BOX 17460
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-0460
Mailing Address - Country:US
Mailing Address - Phone:808-791-4549
Mailing Address - Fax:808-845-4735
Practice Address - Street 1:89 S KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-4315
Practice Address - Country:US
Practice Address - Phone:808-792-5560
Practice Address - Fax:808-792-5577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPHY-7973336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI51863101Medicaid
2129437OtherPK