Provider Demographics
NPI:1952066474
Name:WAIKIKI HEALTH
Entity Type:Organization
Organization Name:WAIKIKI HEALTH
Other - Org Name:WAIKIKI HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:MARUYAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-537-8418
Mailing Address - Street 1:277 OHUA AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-3695
Mailing Address - Country:US
Mailing Address - Phone:808-922-4787
Mailing Address - Fax:
Practice Address - Street 1:277 OHUA AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-3695
Practice Address - Country:US
Practice Address - Phone:808-922-4787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAIKIKI HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-01
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1FDUF5GN5LED42948OtherVEHICLE REGISTRATION NUMBER