NPIMap

Organization Active NPI

Kahuku Medical Center

  • Family Medicine Physician
  • Haleiwa, HI
National Provider Identifier
1639666233
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
KAHUKU MEDICAL CENTER
Doing business as
The Clinic in Haleiwa
Practice address
66-214 Haleiwa Rd
Haleiwa, HI 96712-1510
Phone
(808) 293-9221
NPI assigned
Apr 18, 2018
Organization subpart
Yes
Parent organization
KAHUKU MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Authorized official

Name
Mrs. Rachel Ann Cristobal
Title
Director of Revenue Cycle
Phone
(808) 293-6269

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

66-214 Haleiwa Rd
Haleiwa, HI 96712-1510

Mailing address

56-117 Pualalea St
Kahuku, HI 96731-2052
Phone (808) 293-9221

Other identifiers 1

IdentifierTypeStateIssuer
DM527AMedicaidHI

Other names 1

  • The Clinic in Haleiwa Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Kahuku Medical Center4 organizations share this tax ID, including this one
Part of
Kahuku Medical Center

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1524009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1639666233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56-117 PUALALEA ST",
            "city": "KAHUKU",
            "state": "HI",
            "postal_code": "967312052",
            "telephone_number": "808-293-9221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66-214 HALEIWA RD",
            "city": "HALEIWA",
            "state": "HI",
            "postal_code": "967121510",
            "telephone_number": "808-293-9221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAHUKU MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KAHUKU MEDICAL CENTER",
        "enumeration_date": "2018-04-18",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "CRISTOBAL",
        "authorized_official_first_name": "RACHEL",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "DIRECTOR  OF REVENUE CYCLE",
        "authorized_official_telephone_number": "808-293-6269",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DM527A",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Clinic in Haleiwa",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Clinic in Haleiwa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Haleiwa, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.