NPIMap

Organization Active NPI

Kokua Kalihi Valley Comprehensive Family Services

  • Federally Qualified Health Center (FQHC)
  • Honolulu, HI
National Provider Identifier
1114074622
Registry record updated Nov 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES
Practice address
2239 N School St
Honolulu, HI 96819-2539
Phone
(808) 791-9400
Fax
(808) 848-0979
NPI assigned
Jan 5, 2007
Last updated
Nov 25, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. David Derauf, MDNPI 1245305523
Title
Executive Director
Phone
(808) 791-9400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

2239 N School St
Honolulu, HI 96819-2539

Mailing address

2239 N School St
Honolulu, HI 96819-2539
Phone (808) 791-9400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20101124000442 HI Part A Provider - Federally Qualified Health Center (FQHC) 0547258741 Practice locations: Honolulu, HI
O20190401001159 HI Part B Supplier - Clinic/Group Practice 0547258741 Receives reassigned benefits from 39 practitioners
4 other NPIs on this enrollment
Practice locations: Honolulu, HI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114074622. Details of each certification follow.

Federally qualified health center certification: CCN 121800

Legal name
KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES
Certification status
Terminated Voluntary: merger or closure, Feb 24, 2009
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
May 17, 1972 in HI
Enrollment address
2239 N School St
Honolulu, HI 96819-2539

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

938 Austin Ln
Honolulu, HI 96817

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Thomas Kusatsu Individual Corporate DirectorBoard Vice President & Board Treasu Jun 27, 2013
David D Derauf Individual Corporate OfficerChief Executive Officer Jul 1, 2003
W-2 Managing EmployeeChief Executive Officer Jul 1, 2003
Operational/Managerial ControlChief Executive Officer Jul 1, 2003
Faith Saito Individual Corporate DirectorBoard Member Jun 9, 2022
Vanessa Arbie Dacumos Individual Corporate DirectorBoard Secretary Dec 15, 2018
Sandra Harvey Individual Corporate DirectorBoard President May 4, 2017
Pua Auyong White Individual Corporate DirectorBoard Member Feb 12, 2013
Beverly Killion Individual Corporate DirectorBoard Member Jan 1, 2023
Karen K Fox Individual Corporate DirectorBoard Member Jan 2, 1982
Rickey S Murashige Individual Corporate DirectorBoard Member Feb 12, 2013
Edward C Kemper Individual Corporate DirectorBoard Member Sep 24, 2010
Chan Hou Lei Individual Corporate OfficerChief Financial Officer Apr 1, 2021
David Nakamoto Individual Corporate DirectorBoard Member Sep 24, 2010
Paulina Robert Individual Corporate DirectorBoard Member Jan 1, 2020

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • David Douglas Derauf, MD
    • Public Health & General Preventive Medicine Physician
    • Honolulu, HI
    • NPI 1245305523

    Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 49

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 49

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416873600000",
    "number": "1114074622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2239 N SCHOOL ST",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968192539",
            "telephone_number": "808-791-9400",
            "fax_number": "808-848-0979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2239 N SCHOOL ST",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968192539",
            "telephone_number": "808-791-9400",
            "fax_number": "808-848-0979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2014-11-25",
        "status": "A",
        "authorized_official_last_name": "DERAUF",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "808-791-9400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Honolulu, HI

Sources for this page

Verify at the official NPI Registry.