# MAUNA KEA MEDICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871091801
- **Authorized official:** DR. JOHN DOUGLAS STOVER (DELEGATED OFFICIAL)
- **Authorized official phone:** (808) 960-5412

## Contact information

- **Practice address:** 64-1035 MAMALAHOA HWY STE K, KAMUELA, HI 96743-8440
- **Practice address phone:** (808) 883-9785
- **Practice address fax:** (808) 883-9683
- **Mailing address:** 64-1035 MAMALAHOA HWY STE K, KAMUELA, HI 96743-8440
- **Mailing address phone:** (808) 883-9785
- **Mailing address fax:** (808) 883-9683

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 18437 | HI | Yes |

## Other

- **Enumeration date:** 01/24/2018
- **Last updated:** 01/24/2018