1689896953 NPI number — KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689896953 NPI number — KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES
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:
6
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:
1689896953
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2239 NORTH SCHOOL STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-791-9400
Provider Business Mailing Address Fax Number:
808-848-0979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1846 GULICK AVENUE
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:
96819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-848-0977
Provider Business Practice Location Address Fax Number:
808-848-8689
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DERAUF
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
808-791-9400

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  261QH100X , 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)

  • Identifier: 121838 . This is a "MEDICARE ID" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00992101 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com