Provider Demographics
NPI:1265184352
Name:KOOLAU ANESTHESIA GROUP, LLC
Entity type:Organization
Organization Name:KOOLAU ANESTHESIA GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FUJIMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-341-7354
Mailing Address - Street 1:44-668 KUONO PL
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2539
Mailing Address - Country:US
Mailing Address - Phone:415-341-7354
Mailing Address - Fax:
Practice Address - Street 1:44-668 KUONO PL
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-2539
Practice Address - Country:US
Practice Address - Phone:415-341-7354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty