1295928497 NPI number — WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INC

Table of content: (NPI 1295928497)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295928497 NPI number — WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LEEWARD PEDIATRICS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295928497
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
86-260 FARRINGTON HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAIANAE
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96792-3128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-696-7081
Provider Business Mailing Address Fax Number:
808-696-7093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
87-2070 FARRINGTON HWY
Provider Second Line Business Practice Location Address:
LEEWARD PEDIATRICS, SUITE N
Provider Business Practice Location Address City Name:
NANAKULI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96792-3756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-696-7081
Provider Business Practice Location Address Fax Number:
808-696-7093
Provider Enumeration Date:
08/21/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHEN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Z
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
808-696-7081

Provider Taxonomy Codes

  • Taxonomy code: 261QF0050X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00934901 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".