Provider Demographics
NPI:1578699799
Name:MANAKAI O MALAMA INTEGRATIVE
Entity Type:Organization
Organization Name:MANAKAI O MALAMA INTEGRATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ZUNIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-535-5555
Mailing Address - Street 1:MANAKAI O MALAMA INTEGRATIVE
Mailing Address - Street 2:677 ALA MOANA BLVD, #950
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:808-535-5555
Mailing Address - Fax:808-535-5556
Practice Address - Street 1:MANAKAI O MALAMA INTEGRATIVE
Practice Address - Street 2:677 ALA MOANA BLVD, #950
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-535-5555
Practice Address - Fax:808-535-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI9525570Medicaid
HI9525570Medicaid