1720366545 NPI number — FORREST ALDEN KAIAO WELLS MHC, NCC

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 1720366545 NPI number — FORREST ALDEN KAIAO WELLS MHC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WELLS
Provider First Name:
FORREST
Provider Middle Name:
ALDEN KAIAO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MHC, NCC
Provider Gender Code:
M

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:
1720366545
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41-024 HIHIMANU ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAIMANALO
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96795-1606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-222-3588
Provider Business Mailing Address Fax Number:
808-262-2747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 AULIKE ST
Provider Second Line Business Practice Location Address:
SUIT 411
Provider Business Practice Location Address City Name:
KAILUA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96734-2758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-222-3588
Provider Business Practice Location Address Fax Number:
808-262-2747
Provider Enumeration Date:
07/27/2011

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: 101YM0800X , with the licence number:  MHC 263 , 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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