Organization
KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES
Active
Organization
KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES
Active
Other names
KPT Satellite Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID DERAUF MD (EXECUTIVE DIRECTOR)
(808) 791-9400
Entity
Organization
Contact information
Practice address
1475 LINAPUNI ST BLDG A, HONOLULU, HI 96819-3569
(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
261QH0100X
Health Service Clinic/Center
Primary
261QH0100X
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00992101
—
HI
01
—
121837
MEDICARE ID
HI
Enumeration date
05/03/2007
Last updated
11/25/2014
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