Provider Demographics
NPI:1881437168
Name:SKIN KAHALA LLC
Entity type:Organization
Organization Name:SKIN KAHALA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-808-1324
Mailing Address - Street 1:4819 KILAUEA AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5712
Mailing Address - Country:US
Mailing Address - Phone:310-709-5492
Mailing Address - Fax:808-808-1324
Practice Address - Street 1:4819 KILAUEA AVE STE 7
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5712
Practice Address - Country:US
Practice Address - Phone:310-709-5492
Practice Address - Fax:808-808-1324
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SKIN KAHALA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-14
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty