Provider Demographics
NPI:1205112109
Name:KEIKI KORNER PEDIATRICS
Entity type:Organization
Organization Name:KEIKI KORNER PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEILA
Authorized Official - Middle Name:M
Authorized Official - Last Name:AGULLANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-674-9600
Mailing Address - Street 1:1001 KAMOKILA BLVD
Mailing Address - Street 2:SUITE 197
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2014
Mailing Address - Country:US
Mailing Address - Phone:808-674-9600
Mailing Address - Fax:808-674-9700
Practice Address - Street 1:1001 KAMOKILA BLVD
Practice Address - Street 2:SUITE 197
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2014
Practice Address - Country:US
Practice Address - Phone:808-674-9600
Practice Address - Fax:808-674-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI12344261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care