Provider Demographics
NPI:1104916840
Name:KIDNEY CARE OF HAWAII, LLC
Entity type:Organization
Organization Name:KIDNEY CARE OF HAWAII, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIRAJ
Authorized Official - Middle Name:SURESH
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-632-0200
Mailing Address - Street 1:PO BOX 576
Mailing Address - Street 2:
Mailing Address - City:ELEELE
Mailing Address - State:HI
Mailing Address - Zip Code:96705-0576
Mailing Address - Country:US
Mailing Address - Phone:808-632-0200
Mailing Address - Fax:808-632-0201
Practice Address - Street 1:4473 PAHEE ST STE L
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-2037
Practice Address - Country:US
Practice Address - Phone:808-632-0200
Practice Address - Fax:808-632-0201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD10952174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH101099Medicare ID - Type UnspecifiedGROUP ID