NPIMap

Organization Active NPI

Kahala Clinic Intensive Treatment Program

  • Adolescent and Children Mental Health Clinic/Center
  • Honolulu, HI
National Provider Identifier
1306361241
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
GE-090-260-8896-01 Issued in HI
Legal business name
KAHALA CLINIC INTENSIVE TREATMENT PROGRAM
Practice address
4211 Waialae Ave Ste 208
Honolulu, HI 96816-5312
Phone
(808) 888-5228
Fax
(808) 732-6433
NPI assigned
Aug 12, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Jason Richard Keifer, MD
Title
President
Phone
(808) 888-5228

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X GE-090-260-8896-01 HI Primary

Addresses

Primary practice location

4211 Waialae Ave Ste 208
Honolulu, HI 96816-5312

Mailing address

4211 Waialae Ave Ste 208
Honolulu, HI 96816-5312
Phone (808) 888-5228

National Provider Directory

National Provider Directory

Locations

4211 Waialae Ave
Ste 208
Honolulu, HI 96816
Phone (808) 542-7349

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1502496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1306361241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4211 WAIALAE AVE STE 208",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968165312",
            "telephone_number": "808-888-5228",
            "fax_number": "808-732-6433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4211 WAIALAE AVE STE 208",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968165312",
            "telephone_number": "808-888-5228",
            "fax_number": "808-732-6433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAHALA CLINIC INTENSIVE TREATMENT PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-12",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "KEIFER",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "808-888-5228",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "HI",
            "license": "GE-090-260-8896-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Honolulu, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.