Provider Demographics
NPI:1124262894
Name:J NOHEA KAAWALOA MD INC
Entity type:Organization
Organization Name:J NOHEA KAAWALOA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREM
Authorized Official - Middle Name:NOHEA
Authorized Official - Last Name:KAAWALOA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-933-1120
Mailing Address - Street 1:670 PONAHAWAI ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2660
Mailing Address - Country:US
Mailing Address - Phone:808-933-1120
Mailing Address - Fax:808-933-1125
Practice Address - Street 1:670 PONAHAWAI ST
Practice Address - Street 2:SUITE 220
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2660
Practice Address - Country:US
Practice Address - Phone:808-933-1120
Practice Address - Fax:808-933-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-14077207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty