Provider Demographics
NPI:1538611173
Name:KA'U WELLNESS LLC
Entity type:Organization
Organization Name:KA'U WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER-MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOEDE
Authorized Official - Middle Name:DEAWN
Authorized Official - Last Name:DONAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:808-939-8100
Mailing Address - Street 1:PO BOX 6065
Mailing Address - Street 2:
Mailing Address - City:OCEAN VIEW
Mailing Address - State:HI
Mailing Address - Zip Code:96737-6065
Mailing Address - Country:US
Mailing Address - Phone:808-939-8100
Mailing Address - Fax:808-829-3672
Practice Address - Street 1:92-8691 LOTUS BLOSSOM LANE
Practice Address - Street 2:#6-7
Practice Address - City:OCEAN VIEW
Practice Address - State:HI
Practice Address - Zip Code:96737-6065
Practice Address - Country:US
Practice Address - Phone:808-939-8100
Practice Address - Fax:808-829-3672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-31
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 2084B0040X, 261QP2000X
HIDOS-1310261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI692584Medicaid