NPIMap

Organization Active NPI

Kalihi-Palama Health Center

  • Clinic/Center
  • Honolulu, HI
National Provider Identifier
1669644068
Registry record updated Mar 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
W20300018-01 Issued in HI
Legal business name
KALIHI-PALAMA HEALTH CENTER
Practice address
89-91 S. King Street
Honolulu, HI 96813
Phone
(808) 792-5566
Fax
(808) 792-5577
NPI assigned
Mar 26, 2008
Last updated
Mar 26, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
KALIHI-PALAMA HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 26, 2008

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

Authorized official

Name
Monique Vanderaa
Title
Cfo
Phone
(808) 843-7238

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X W20300018-01 HI Primary

Addresses

Primary practice location

89-91 S. King Street
Honolulu, HI 96813

Mailing address

915 N King St
Honolulu, HI 96817-4544
Phone (808) 848-1438

Other names 1

  • KPHC Downtown Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071221000565 HI Part A Provider - Federally Qualified Health Center (FQHC) 4284544842 Practice locations: Honolulu, HI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669644068. Details of each certification follow.

Federally qualified health center certification: CCN 121835

Legal name
KALIHI PALAMA HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 8, 2008
Last certification
Feb 8, 2008
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 24, 1975 in HI
Enrollment address
89 S King St
Honolulu, HI 96813-4315

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Glenn a Rediger MD13 organizations share this tax ID, including this one
Part of
Glenn a Rediger MD

Other organizations with this tax ID 12

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

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Emmanuel Kintu Individual Corporate OfficerCeo/Executive Director Apr 24, 2006
W-2 Managing EmployeeCeo/Executive Director Oct 8, 2015 100%
Liane L Sugimoto Individual Corporate OfficerCfo/Chief Financial Officer Mar 8, 2010
Darrin Sato Individual Corporate OfficerCoo/Chief Operations Officer Apr 24, 2005
Vernon Y Nakamura Individual Corporate OfficerBoard President Dec 8, 2011
Peter K Hanashiro Individual Corporate OfficerTreasuer of the Board Dec 8, 2011

Practitioners & affiliated clinicians

Practitioners 1

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": "1206489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206489600000",
    "number": "1669644068",
    "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": "808-848-1438",
            "fax_number": "808-841-1265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "89-91 S. KING STREET",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "96813",
            "telephone_number": "808-792-5566",
            "fax_number": "808-792-5577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KALIHI-PALAMA HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KALIHI-PALAMA HEALTH CENTER",
        "enumeration_date": "2008-03-26",
        "last_updated": "2008-03-26",
        "status": "A",
        "authorized_official_last_name": "VANDERAA",
        "authorized_official_first_name": "MONIQUE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "808-843-7238"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "HI",
            "license": "W20300018-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KPHC Downtown",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Honolulu, HI

Sources for this page

Verify at the official NPI Registry.