Organization
KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID D DERAUF MD (EXECUTIVE DIRECTOR)
(808) 791-9400
Entity
Organization
Contact information
Practice address
2229 N SCHOOL ST, HONOLULU, HI 96819-2588
(808) 791-9400
(808) 848-0979
Mailing address
2239 N SCHOOL ST, HONOLULU, HI 96819-2539
(808) 791-9400
(808) 848-0979
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
121847
MEDICARE ID
HI
05
—
697336
—
HI
Enumeration date
05/30/2012
Last updated
11/25/2014
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