Provider Demographics
NPI:1689024895
Name:KEN HEALTH CARE INTERNATIONAL, INC.
Entity Type:Organization
Organization Name:KEN HEALTH CARE INTERNATIONAL, INC.
Other - Org Name:KEN HEALTH CARE HAWAII CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEIDCAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-367-0513
Mailing Address - Street 1:2250 KALAKAUA AVE
Mailing Address - Street 2:SUITE 407
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-2542
Mailing Address - Country:US
Mailing Address - Phone:808-367-0513
Mailing Address - Fax:808-367-0514
Practice Address - Street 1:2250 KALAKAUA AVE
Practice Address - Street 2:SUITE 407
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-2542
Practice Address - Country:US
Practice Address - Phone:808-367-0513
Practice Address - Fax:808-367-0514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-18
Last Update Date:2016-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI18532261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care