Provider Demographics
NPI:1609378504
Name:KAILUA INTEGRATIVE MEDICINE LLC
Entity Type:Organization
Organization Name:KAILUA INTEGRATIVE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:OPUNUI
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:808-779-4669
Mailing Address - Street 1:354 ULUNIU ST STE 404
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2534
Mailing Address - Country:US
Mailing Address - Phone:808-779-4669
Mailing Address - Fax:
Practice Address - Street 1:354 ULUNIU ST STE 404
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2534
Practice Address - Country:US
Practice Address - Phone:808-779-4669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIND-251175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIND-251OtherMULTI-SPECIALTY HEALTH CARE