# KOA COMMUNITY CLINIC, INC

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

## Provider details

- **NPI number:** 1952920555
- **Authorized official:** DR. CORINNE MAUL DE SOTO (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (808) 638-3343

## Contact information

- **Practice address:** 75-5995 KUAKINI HWY STE 213, KAILUA KONA, HI 96740-2120
- **Practice address phone:** (808) 638-3343
- **Practice address fax:** (844) 308-3545
- **Mailing address:** 75-5995 KUAKINI HWY STE 213, KAILUA KONA, HI 96740-2120
- **Mailing address phone:** (808) 638-3343
- **Mailing address fax:** (844) 308-3545

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | — | NULL | Yes |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 04/13/2020
- **Last updated:** 07/03/2024