Provider Demographics
NPI:1790114536
Name:OHANA MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:OHANA MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FILBECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-380-3980
Mailing Address - Street 1:407 ULUNIU STREET
Mailing Address - Street 2:SUITE 113
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734
Mailing Address - Country:US
Mailing Address - Phone:808-380-3980
Mailing Address - Fax:866-296-0131
Practice Address - Street 1:407 ULUNIU STREET
Practice Address - Street 2:SUITE 113
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:808-380-3980
Practice Address - Fax:866-296-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 208D00000X, 363L00000X, 363LF0000X
HIMD-10932207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH104538Medicare UPIN