Provider Demographics
NPI:1558839589
Name:KIDSHINE KAPOLEI LLC
Entity Type:Organization
Organization Name:KIDSHINE KAPOLEI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOSPITAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSI-CHARET
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:086-383-3328
Mailing Address - Street 1:850 KAMEHAMEHA HWY STE 215
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2603
Mailing Address - Country:US
Mailing Address - Phone:808-638-3332
Mailing Address - Fax:808-427-5136
Practice Address - Street 1:590 FARRINGTON HWY UNIT 155
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2011
Practice Address - Country:US
Practice Address - Phone:808-427-9987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental