NPIMap

Organization Active NPI

Koa Clinic, Inc

Doing business as Koa Clinic of Integrative Healing

  • Clinic/Center
  • Kailua Kona, HI
National Provider Identifier
1528576436
Registry record updated Jul 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
258 Issued in HI
Legal business name
KOA CLINIC, INC
Doing business as
Koa Clinic of Integrative Healing
Practice address
75-5995 Kuakini Hwy Ste 213
Kailua Kona, HI 96740-2120
Phone
(808) 638-3343
Fax
(844) 308-3545
NPI assigned
Jan 12, 2018
Last updated
Jul 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2024

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

Authorized official

Name
Dr. Corinne Maul de Soto, NDNPI 1841603651
Title
President
Phone
(808) 638-3343

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 258 HI Primary
Primary Care Clinic/Center 261QP2300X
General Practice Physician 208D00000X

Addresses

Primary practice location

75-5995 Kuakini Hwy Ste 213
Kailua Kona, HI 96740-2120

Mailing address

75-5995 Kuakini Hwy Ste 213
Kailua Kona, HI 96740-2120
Phone (808) 638-3343

Other names 1

  • Koa Clinic of Integrative Healing Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210119001271 HI Part B Supplier - Clinic/Group Practice 2567875297 Receives reassigned benefits from 1 practitioner
Practice locations: Kailua Kona, HI

National Provider Directory

National Provider Directory

Locations

75-5995 Kuakini Hwy
Ste 445
Kailua Kona, HI 96740
Phone (808) 315-8466

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1515715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719964800000",
    "number": "1528576436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75-5995 KUAKINI HWY STE 213",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "967402120",
            "telephone_number": "808-638-3343",
            "fax_number": "844-308-3545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75-5995 KUAKINI HWY STE 213",
            "city": "KAILUA KONA",
            "state": "HI",
            "postal_code": "967402120",
            "telephone_number": "808-638-3343",
            "fax_number": "844-308-3545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOA CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-12",
        "last_updated": "2024-07-03",
        "certification_date": "2023-09-06",
        "status": "A",
        "authorized_official_last_name": "MAUL DE SOTO",
        "authorized_official_first_name": "CORINNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "808-638-3343",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ND"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "HI",
            "license": "258",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Koa Clinic of Integrative Healing",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kailua Kona, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.