Provider Demographics
NPI:1639666233
Name:KAHUKU MEDICAL CENTER
Entity Type:Organization
Organization Name:KAHUKU MEDICAL CENTER
Other - Org Name:THE CLINIC IN HALEIWA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CRISTOBAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-293-6269
Mailing Address - Street 1:56-117 PUALALEA ST
Mailing Address - Street 2:
Mailing Address - City:KAHUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96731-2052
Mailing Address - Country:US
Mailing Address - Phone:808-293-9221
Mailing Address - Fax:
Practice Address - Street 1:66-214 HALEIWA RD
Practice Address - Street 2:
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-1510
Practice Address - Country:US
Practice Address - Phone:808-293-9221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAHUKU MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-18
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIDM527AMedicaid