Provider Demographics
NPI:1548521164
Name:KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES
Entity type:Organization
Organization Name:KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:DERAUF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-791-9400
Mailing Address - Street 1:2239 N SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-2539
Mailing Address - Country:US
Mailing Address - Phone:808-791-9400
Mailing Address - Fax:808-848-0979
Practice Address - Street 1:2229 N SCHOOL ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-2588
Practice Address - Country:US
Practice Address - Phone:808-791-9400
Practice Address - Fax:808-848-0979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI121847OtherMEDICARE ID
HI697336Medicaid
HIHKKVHMedicare UPIN