Provider Demographics
NPI:1194909986
Name:MAUI KIDNEY DISEASE, INC.
Entity type:Organization
Organization Name:MAUI KIDNEY DISEASE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOMA
Authorized Official - Middle Name:HARRISON
Authorized Official - Last Name:HASSELL
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:808-280-9638
Mailing Address - Street 1:PO BOX 811
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-0811
Mailing Address - Country:US
Mailing Address - Phone:808-280-9638
Mailing Address - Fax:844-342-7003
Practice Address - Street 1:567 KUPULAU DR
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-6316
Practice Address - Country:US
Practice Address - Phone:808-280-9638
Practice Address - Fax:844-342-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty