NPIMap

Organization Active NPI

Waianae District Comprehensive Health and Hospital Board, Incorporated

Doing business as Waiola Clinic

  • Federally Qualified Health Center (FQHC)
  • Waianae, HI
National Provider Identifier
1164597795
Registry record updated Nov 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED
Doing business as
Waiola Clinic
Practice address
86-120 Farrington Hwy
Suite C305A
Waianae, HI 96792-3000
Phone
(808) 697-3300
Fax
(808) 697-3687
NPI assigned
Nov 21, 2006
Last updated
Nov 21, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 21, 2025

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

Authorized official

Name
Cindy Yee
Title
Chief Financial Officer
Phone
(808) 697-3128

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Non-Surgical Family Planning Clinic/Center 261QF0050X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Multi-Specialty Clinic/Center 261QM1300X
Primary Care Clinic/Center 261QP2300X
Urgent Care Clinic/Center 261QU0200X

Addresses

Primary practice location

86-120 Farrington Hwy
Suite C305A
Waianae, HI 96792-3000

Mailing address

86-260 Farrington Hwy
Waianae, HI 96792-3128
Phone (808) 697-3300

Other names 1

  • Waiola Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070216000694 HI Part A Provider - Federally Qualified Health Center (FQHC) 9931008349 Practice locations: Waianae, HI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164597795. Details of each certification follow.

Federally qualified health center certification: CCN 121833

Legal name
WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD INCORPORATED
Doing business as
WAIOLA CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 2, 2007
Last certification
May 2, 2007
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 6, 1969 in HI
Enrollment address
86-120 Farrington Hwy
Ste C305A
Waianae, HI 96792-3072

Other NPIs with the same Medicare PAC ID 16

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

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Waianae Dist Comp HTH Hosp39 organizations share this tax ID, including this one
Part of
Waianae Dist Comp HTH Hosp

Other organizations with this tax ID 38

Organizations that report the same tax identification number in the National Provider Directory.

View all 38

Locations

86-120 Farrington Hwy
#C305A
Waianae, HI 96792

Ownership & related parties

All disclosed owners & managing parties 22

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

NameRoleSinceShare
Genevieve Aken Individual Other May 19, 2020
Dane K Lloyd Individual Other May 5, 2012
Charles Hew-Len Individual Other May 18, 2015
Clifford K Isara Individual Other Nov 15, 2007
Desire de Soto Individual Other May 21, 2024
Richard P Bettini Individual W-2 Managing EmployeeChief Executive Officer Jul 1, 1993
Other Jul 1, 1993
Marianne Glushenko Individual Other May 21, 2024
Lajuaine C Suiso Individual Other May 5, 2012
Merrie L Aipoalani Individual Other Nov 15, 2007
Denice Keliikoa Individual Other May 18, 2015
Deroy Lavatai Individual Other May 16, 2023
Anthony Paris Individual Other Apr 20, 2021
Billie J Hauge Individual Other Mar 17, 2014
Tesha Malama Individual Other May 17, 2022
Judith Babson Individual Other May 21, 2018
Todd Nitta Individual Other Jul 25, 2023
Cindy Yee Individual W-2 Managing EmployeeChief Financial Officer Nov 25, 2019
Virginia M Fuata Individual Other Nov 15, 2007
Renee J Rego Individual Other May 20, 2010
Florine D Pell Individual Other May 18, 2015
Wayne K Suehiro Individual Other Nov 15, 2007
Daniel H Gomes Individual Other Nov 15, 2007

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The Comp at Tamura Super MarketWaianae, HI, CCN 121878 Federally qualified health center Operational/Managerial Control May 6, 1969
Makaha HealthWaianae, HI, CCN 121021 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1972

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763683200000",
    "number": "1164597795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86-260 FARRINGTON HWY",
            "city": "WAIANAE",
            "state": "HI",
            "postal_code": "967923128",
            "telephone_number": "808-697-3300",
            "fax_number": "808-697-3687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "86-120 FARRINGTON HWY",
            "address_2": "SUITE C305A",
            "city": "WAIANAE",
            "state": "HI",
            "postal_code": "967923000",
            "telephone_number": "808-697-3300",
            "fax_number": "808-697-3687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED",
        "enumeration_date": "2006-11-21",
        "last_updated": "2025-11-21",
        "certification_date": "2025-11-21",
        "status": "A",
        "authorized_official_last_name": "YEE",
        "authorized_official_first_name": "CINDY",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "808-697-3128"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Family Planning, Non-Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waiola Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waianae, HI

Sources for this page

Verify at the official NPI Registry.