Provider Demographics
NPI:1679646509
Name:WAIKIKI HEALTH
Entity Type:Organization
Organization Name:WAIKIKI HEALTH
Other - Org Name:WAIKIKI HEALTH OHUA CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RD, MPH
Authorized Official - Phone:808-791-9302
Mailing Address - Street 1:277 OHUA AVENUE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-3643
Mailing Address - Country:US
Mailing Address - Phone:808-922-4787
Mailing Address - Fax:808-922-6454
Practice Address - Street 1:277 OHUA AVENUE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-3643
Practice Address - Country:US
Practice Address - Phone:808-922-4787
Practice Address - Fax:808-922-6454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04701301Medicaid
HI121814Medicare Oscar/Certification