Provider Demographics
NPI:1285353508
Name:KONA FOOT CARE, LLC
Entity type:Organization
Organization Name:KONA FOOT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHRIS
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:808-300-8606
Mailing Address - Street 1:PO BOX 2148
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96745-2148
Mailing Address - Country:US
Mailing Address - Phone:808-300-8606
Mailing Address - Fax:808-657-6833
Practice Address - Street 1:77-6403 NALANI ST STE 104
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-9763
Practice Address - Country:US
Practice Address - Phone:808-300-8606
Practice Address - Fax:808-657-6833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty