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Organization Active NPI

Kalihi-Palama Health Center

  • Federally Qualified Health Center (FQHC)
  • Honolulu, HI
National Provider Identifier
1508889379
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
W20300018-01
Legal business name
KALIHI-PALAMA HEALTH CENTER
Practice address
904 Kohou St
Honolulu, HI 96817-4420
Phone
(808) 791-6370
Fax
(808) 842-3117
NPI assigned
Jul 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Victoria K Lancaster
Title
Patient Accounting Manager
Phone
(808) 843-7239

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X W20300018-01 Primary

Addresses

Primary practice location

904 Kohou St
Honolulu, HI 96817-4420

Mailing address

915 N King St
Honolulu, HI 96817-4544
Phone (808) 843-7239

Other identifiers 1

IdentifierTypeStateIssuer
51863104MedicaidHI

Other names 1

  • Kohou Clinic HCHP Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060309000345 HI Part A Provider - Federally Qualified Health Center (FQHC) 4284544842 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Honolulu, HI

Federally qualified health center certification: CCN 121803

Legal name
KALIHI PALAMA HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 19, 1993
Last certification
Jul 19, 1993
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Mar 24, 1975 in HI
Enrollment address
915 N King St
Honolulu, HI 96817-4544

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory

Locations

904 Kohou St
Honolulu, HI 96817
Phone (808) 791-6370

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Mattlie Davis Individual Corporate DirectorBoard Member Sep 21, 2011
Christopher Pating Individual Corporate DirectorBoard Member Feb 16, 2011
Emmanuel Kintu Individual Corporate OfficerCeo/Executive Director Apr 24, 2005
W-2 Managing EmployeeCeo/Executive Director Apr 24, 2005 100%
Russell Kaupu Individual Corporate DirectorBoard Member Feb 16, 2011
Liane L Sugimoto Individual Corporate OfficerCfo/Chief Financial Officer Mar 8, 2010
Darrin Sato Individual Corporate OfficerCoo/Chief Operation Officer Apr 24, 2005
Rosemarie V Mendoza Individual Corporate DirectorBoard Member May 13, 2009
Vernon Y Nakamura Individual Corporate OfficerBoard President Dec 8, 2011
Peter K Hanashiro Individual Corporate OfficerTreasurer of the Board Dec 8, 2011
Clifford Chang Individual Corporate DirectorBoard Member Jul 12, 2000
Siu Lo L Li Individual Corporate OfficerSecretary PF the Board Dec 8, 2011
Dawn Hirai Individual Corporate DirectorBoard Member Jan 1, 2008

NPI Registry JSON

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508889379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 N KING ST",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968174544",
            "telephone_number": "808-843-7239",
            "fax_number": "808-841-1265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 KOHOU ST",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968174420",
            "telephone_number": "808-791-6370",
            "fax_number": "808-842-3117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KALIHI-PALAMA HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LANCASTER",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PATIENT ACCOUNTING MANAGER",
        "authorized_official_telephone_number": "808-843-7239"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": "W20300018-01",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "51863104",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kohou Clinic HCHP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Honolulu, HI

Sources for this page

Verify at the official NPI Registry.