Provider Demographics
NPI:1205124286
Name:KOKUA TRANSPORT, LLC
Entity type:Organization
Organization Name:KOKUA TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAMINO
Authorized Official - Middle Name:GALLARDO
Authorized Official - Last Name:DUPAYA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:808-779-4210
Mailing Address - Street 1:4324 ORION DR APT D
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-3635
Mailing Address - Country:US
Mailing Address - Phone:808-888-5964
Mailing Address - Fax:
Practice Address - Street 1:4324 ORION DR APT D
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-3635
Practice Address - Country:US
Practice Address - Phone:808-888-5964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI379-C343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)