Provider Demographics
NPI:1306262886
Name:KAWA, SAMANTHA (OD)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:KAWA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 IA IKI ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-4172
Mailing Address - Country:US
Mailing Address - Phone:808-446-9163
Mailing Address - Fax:
Practice Address - Street 1:32 PAA ST
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-3605
Practice Address - Country:US
Practice Address - Phone:088-777-8288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-08
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4724152W00000X
HI875152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIB831ZMedicare PIN