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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