Provider Demographics
NPI:1659531622
Name:KAUAI COMMUNITY HEALTH ALLIANCE
Entity Type:Organization
Organization Name:KAUAI COMMUNITY HEALTH ALLIANCE
Other - Org Name:HALE LE'A MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROGOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-828-2885
Mailing Address - Street 1:2460 OKA ST
Mailing Address - Street 2:101-A
Mailing Address - City:KILAUEA
Mailing Address - State:HI
Mailing Address - Zip Code:96754-5308
Mailing Address - Country:US
Mailing Address - Phone:808-828-2882
Mailing Address - Fax:808-828-0119
Practice Address - Street 1:2460 OKA ST
Practice Address - Street 2:101-A
Practice Address - City:KILAUEA
Practice Address - State:HI
Practice Address - Zip Code:96754-5308
Practice Address - Country:US
Practice Address - Phone:808-828-2882
Practice Address - Fax:808-828-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11990261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health