1356511810 NPI number — PAUL A. KAIWI, JR. MD INC

Table of content: (NPI 1356511810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356511810 NPI number — PAUL A. KAIWI, JR. MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAUL A. KAIWI, JR. MD 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:
PROGRESSIVE MEDICAL
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:
1356511810
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
444 HANA HWY
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
KAHULUI
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96732-2315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-877-6333
Provider Business Mailing Address Fax Number:
808-877-7100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
444 HANA HWY
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
KAHULUI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96732-2315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-877-6333
Provider Business Practice Location Address Fax Number:
808-877-7100
Provider Enumeration Date:
03/11/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KAIWI
Authorized Official First Name:
SHAWN
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
808-877-6333

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  MD 13020 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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