Mauna Kea Medical LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

18437 Issued in HI

Legal business name

MAUNA KEA MEDICAL LLC

Practice address

64-1035 Mamalahoa Hwy Ste K
Kamuela, HI 96743-8440

Phone

(808) 883-9785

Fax

(808) 883-9683

NPI assigned

Jan 24, 2018

Last updated

Jan 24, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. John Douglas Stover

Title

Delegated Official

Phone

(808) 960-5412

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1516752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516752000000",
    "number": "1871091801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "64-1035 MAMALAHOA HWY STE K",
            "city": "KAMUELA",
            "state": "HI",
            "postal_code": "967438440",
            "telephone_number": "808-883-9785",
            "fax_number": "808-883-9683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "64-1035 MAMALAHOA HWY STE K",
            "city": "KAMUELA",
            "state": "HI",
            "postal_code": "967438440",
            "telephone_number": "808-883-9785",
            "fax_number": "808-883-9683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAUNA KEA MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-24",
        "last_updated": "2018-01-24",
        "status": "A",
        "authorized_official_last_name": "STOVER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "DELEGATED OFFICIAL",
        "authorized_official_telephone_number": "808-960-5412",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "HI",
            "license": "18437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michaela Annwen Martin, N.D., L.AC
• Robert Lewis Martin Sr., MD
• John Anthony Mascaro, PHD
• Gabriella Mata
• Mauna Kea Dental LLC
• Mauna Kea Sky Counseling LLC
• Milleno Dayzen Mavaega
• Judea Leigh McAnesby, PSYD
• Maureen McLaughlin, L.AC.
• David Hugh McNaughton, M.D.

• Internal Medicine Physician in Kamuela, HI
• Providers in Kamuela, HI by specialty
• Internal Medicine Physician in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2018; 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.