Kau Hospital
Organization Active NPI Rural Health Clinic/Center · Pahoa, HI
NPI 1285450163 · NPPES record last updated Feb 25, 2025
Key facts
- NPI
- 1285450163
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- KAU HOSPITAL
- Practice address
- 15-2714 Pahoa Village Rd Ste 5
Pahoa, HI 96778-9715 - Phone
- (808) 930-6001
- Fax
- (808) 930-6007
- NPI assigned
- Nov 25, 2024
- Organization subpart
- No
Authorized official
- Name
- Joni Mu Waltjen
- Title
- Regional Cfo
- Phone
- (808) 932-3110
Owners & managing parties with NPI records 3
-
Daniel H. Belcher, M.D.
-
Stephen Michael Smith, M.D.
-
Jennifer Junnila Walker, MD, MPH
Other NPIs with the same Medicare PAC ID 8
Corporate family (same tax ID) 7
Related certifications (CCN) 1
Facilities with the same owner 34
Practitioners 229
-
Carli Bullis, M.D.
-
Katrina Chong Tercero, MHS, PA-C
-
Haylee S Chung, APRN
-
Janine Doneza, MD
-
Mie S Fowler, APRN
-
Mark S. Gerber, M.D.
-
Jorge Enrique Guzman, M.D.
-
Heather M Henning, PA-C
-
Laurie W. Hopman, M.D.
-
Angelina T.M Horner, PHD
-
Daniel Robert Hudak, M.D.
-
Timothy C Jahraus, M.D.
-
John P. Kristofich, M.D.
-
Eric Lau, MD
-
Kerry A. Lau, PA
-
Kelly Leialoha Luscomb, N.P.
-
Anna Marie Maisu, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 12D2317832 | East Hawaii Health Clinic at Puna Kai | Certificate of waiver | Jan 30, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in HI
Rural health clinic certification: CCN 123400
- Legal name
- KAU HOSPITAL
- Doing business as
- EAST HAWAII HEALTH CLINIC AT PUNA K
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jun 30, 2025
- Last certification
- Jun 30, 2025
- Ownership / control type
- 2B
- Organization structure
- Other · Non-profit
- Enrollment address
- 15-2714 Pahoa Village Road
Building L, Suite 5
Pahoa, HI 96778 - Related CCNs
- 121301
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| Stephen M Smith |
Corporate Director |
Feb 24, 2018 | |
| Daniel H Belcher |
Corporate Director |
Jul 1, 2023 | |
| Randall Kurohara |
Corporate Director |
Jul 1, 2022 | |
| Lara Gomez |
Corporate Director |
Jul 1, 2022 | |
| Jay M Ignacio |
Corporate Director |
Apr 1, 2019 | |
| Yvonne Wong |
Corporate Director |
Jul 1, 2022 | |
| Daniel John Brinkman |
Corporate Officer |
Jun 22, 2015 | |
| Jennifer J Walker |
Contracted Managing Employee |
Aug 29, 2019 | |
| Chad Keone Farias |
Corporate Director |
Jul 1, 2021 | |
| Joseph F Skruch |
Corporate Director |
Jul 1, 2019 | |
| Deanna S Sako |
Corporate Director |
Sep 1, 2018 | |
| Jennifer L Zelko-Schlueter |
Corporate Director |
Aug 19, 2014 | |
| Joni Mu Waltjen |
Corporate Officer |
Apr 8, 2002 | |
| Juliette M Tulang |
Corporate Director |
Jul 1, 2023 | |
| Hawaii Health Systems Corporation |
5% Or Greater Direct Ownership Interest | Jul 1, 1996 | 100% |
| Clarysse K Nunokawa |
Corporate Director |
Jun 1, 2019 | |
| Lauri E Redus |
W-2 Managing Employee |
Oct 31, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250320000260 | HI | Part a Provider - Rural Health Clinic | 7416945548 | Practice locations: Pahoa, HI |
National Provider Directory
- Tax ID family
- Kau Hospital
Locations
15-2714 Pahoa Village Rd
Ste 5
Pahoa, HI 96778
Phone (808) 930-6001
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
15-2714 Pahoa Village Rd Ste 5
Pahoa, HI 96778-9715
Mailing address
PO Box 40
Pahala, HI 96777-0040
Phone (808) 932-4300
Other names
- East Hawaii Health Clinic at Puna Kai
Other providers in Pahoa, HI
- Eredulin Vigilla Julian
- Kala & Associates, Inc.
- Lisa Kaneshiro
- Kathleen Gorman, LLC
- Kau Hospital
- David Kazmierczak
- Gwen L Keliihoomalu
- Kinesis Hawaii Inc.
- Jason R King
- Robin J Kloda
All providers in Pahoa, HI · Rural Health Clinic/Center in Hawaii
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 25, 2025. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.