Provider Demographics
NPI:1851529580
Name:TRADE WINDS FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:TRADE WINDS FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:KAY MCCAULEY
Authorized Official - Last Name:LUND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:808-372-2420
Mailing Address - Street 1:970 N KALAHEO AVE
Mailing Address - Street 2:STE. C-306
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1866
Mailing Address - Country:US
Mailing Address - Phone:808-263-7383
Mailing Address - Fax:
Practice Address - Street 1:970 N KALAHEO AVE
Practice Address - Street 2:STE. C-306
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1866
Practice Address - Country:US
Practice Address - Phone:808-263-7383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS-856261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI56992301Medicaid
HIH100734Medicare UPIN