Kokua Kalihi Valley Comprehensive Family Services
Organization Active NPI Federally Qualified Health Center (FQHC) · Honolulu, HI
NPI 1114074622 · NPPES record last updated Nov 25, 2014
Key facts
- NPI
- 1114074622
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 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
- Organization subpart
- No
Authorized official
- Name
- Dr. David Derauf, MD
- Title
- Executive Director
- Phone
- (808) 791-9400
Owners & managing parties with NPI records 1
Other NPIs on the same Medicare enrollment 4
Other NPIs with the same Medicare PAC ID 5
Practitioners 50
-
Dawn Taniguchi, MD
-
Calvin Chin, MD
-
Angelica Agapito, MD
-
Tracy Lynne Khan Fernando, MSN,APRN-RX,FNP-BC,A
-
Jennifer Filiatreau, O.D.
-
Melissa A McKinney, D.O.
-
Melanie Nakatani, DNP
-
Melissa M Sutherland, APRN
-
Ruth A Chong, FNP
-
Erin Iwalani Castillo, LCSW
-
Kapono Chang, DO
-
Susanna Yuen Shan Cheng, P.A.-C
-
Julia Kay Fujiki, PSYD
-
Alexis Elizabeth Grieves, DNP, APRN, PMHNP-BC
-
Dustin Ken Teruya, LCSW
-
Carly C Williamson, LCSW
-
Christie H Izutsu, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in HI
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
- Corporation · Non-profit
- Incorporated
- May 17, 1972 in HI
- Enrollment address
- 2239 N School St
Honolulu, HI 96819-2539
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Thomas Kusatsu |
Corporate Director |
Jun 27, 2013 | |
| David D Derauf |
Corporate Officer |
Jul 1, 2003 | |
| W-2 Managing Employee |
Jul 1, 2003 | ||
| Operational/Managerial Control |
Jul 1, 2003 | ||
| Faith Saito |
Corporate Director |
Jun 9, 2022 | |
| Vanessa Arbie Dacumos |
Corporate Director |
Dec 15, 2018 | |
| Sandra Harvey |
Corporate Director |
May 4, 2017 | |
| Pua Auyong White |
Corporate Director |
Feb 12, 2013 | |
| Beverly Killion |
Corporate Director |
Jan 1, 2023 | |
| Karen K Fox |
Corporate Director |
Jan 2, 1982 | |
| Rickey S Murashige |
Corporate Director |
Feb 12, 2013 | |
| Edward C Kemper |
Corporate Director |
Sep 24, 2010 | |
| Chan Hou Lei |
Corporate Officer |
Apr 1, 2021 | |
| David Nakamoto |
Corporate Director |
Sep 24, 2010 | |
| Paulina Robert |
Corporate Director |
Jan 1, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Locations
1846 Gulick Ave
Honolulu, HI 96819
Phone (808) 791-9415
938 Austin Ln
Honolulu, HI 96817
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 121800 | Other | HI | MEDICARE ID |
| 598237 | Medicaid | HI |
Other providers in Honolulu, HI
- Jessica H. Kojima
- Joyann Kojima
- Kryss Y. Kojima
- Kelli Ann Kokame
- Kokua Healthcare
- Kokua Kalihi Valley Comprehensive Family Services
- Kokua Kalihi Valley Comprehensive Family Services
- Kokua Kalihi Valley Comprehensive Family Services
- Kokua Kalihi Valley Comprehensive Family Services
- Kokua Kalihi Valley Comprehensive Family Services
All providers in Honolulu, HI · Federally Qualified Health Center (FQHC) in Hawaii
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 25, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.