1417416991 NPI number — KALANIKAULELEIAIWI AH LEN JARDINE RBT

Table of content: KALANIKAULELEIAIWI AH LEN JARDINE RBT (NPI 1417416991)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417416991 NPI number — KALANIKAULELEIAIWI AH LEN JARDINE RBT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JARDINE
Provider First Name:
KALANIKAULELEIAIWI
Provider Middle Name:
AH LEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RBT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KAAUWAI
Provider Other First Name:
KALANIKAULELEIAIWI
Provider Other Middle Name:
AH LEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417416991
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
316 MID VALLEY CTR # 186
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARMEL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93923-8516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-431-4655
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4359 KUKUI GROVE ST STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIHUE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96766-2008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-431-4655
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X , with the licence number:  RBT-19-80074 , 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)





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