Provider Demographics
NPI:1437744232
Name:MALAMA KINO PRIMARY CARE INC.
Entity Type:Organization
Organization Name:MALAMA KINO PRIMARY CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ALANA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOO-FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:808-320-4333
Mailing Address - Street 1:5141 KAPIOLANI LOOP
Mailing Address - Street 2:
Mailing Address - City:PRINCEVILLE
Mailing Address - State:HI
Mailing Address - Zip Code:96722-5208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4-1461 KUHIO HWY
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1715
Practice Address - Country:US
Practice Address - Phone:808-320-4333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1326587551Medicaid