Provider Demographics
NPI:1922131838
Name:KAHALEWAI, SOLOMON KIMOKEO
Entity Type:Individual
Prefix:
First Name:SOLOMON
Middle Name:KIMOKEO
Last Name:KAHALEWAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 994
Mailing Address - Street 2:
Mailing Address - City:KAUNAKAKAI
Mailing Address - State:HI
Mailing Address - Zip Code:96748-0994
Mailing Address - Country:US
Mailing Address - Phone:808-553-9892
Mailing Address - Fax:808-553-4411
Practice Address - Street 1:325 KAIWI STREET
Practice Address - Street 2:
Practice Address - City:KAUNAKAKAI
Practice Address - State:HI
Practice Address - Zip Code:96748
Practice Address - Country:US
Practice Address - Phone:808-553-9892
Practice Address - Fax:808-553-4411
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI52321801Medicaid