1225893985 NPI number — KAHU HEALTH LLC

Table of content: MADISON LAYNE FEDDERS BS (NPI 1942827217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225893985 NPI number — KAHU HEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAHU HEALTH LLC
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:
Provider Other Organization Name Type Code:
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:
1225893985
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
92-1503 ALIINUI DR # 29E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAPOLEI
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96707-2237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-720-4357
Provider Business Mailing Address Fax Number:
808-204-8997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 BISHOP ST STE 2685A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96813-3404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-720-4357
Provider Business Practice Location Address Fax Number:
808-204-8997
Provider Enumeration Date:
02/20/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
ARI
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
808-720-4357

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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