Provider Demographics
NPI:1407928492
Name:KONA KOHALA HEALTH CARE SERVICES INC
Entity Type:Organization
Organization Name:KONA KOHALA HEALTH CARE SERVICES INC
Other - Org Name:KONA KOHALA MEDI CAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEKALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-329-1346
Mailing Address - Street 1:75-137 HUALALAI RD
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1703
Mailing Address - Country:US
Mailing Address - Phone:808-329-1346
Mailing Address - Fax:808-329-1575
Practice Address - Street 1:75-137 HUALALAI RD
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1703
Practice Address - Country:US
Practice Address - Phone:808-329-1346
Practice Address - Fax:808-329-1575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00A0026490OtherHAWAII MEDICAL SVC ASSOC