Provider Demographics
NPI:1528884657
Name:KUA MANA'O KOKUA LLC
Entity type:Organization
Organization Name:KUA MANA'O KOKUA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:ANN SHINTANI
Authorized Official - Last Name:KUA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP, CARN-AP
Authorized Official - Phone:808-491-5953
Mailing Address - Street 1:99 HOOHUA STREET
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720
Mailing Address - Country:US
Mailing Address - Phone:808-491-5953
Mailing Address - Fax:
Practice Address - Street 1:99 HOOHUA STREET
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720
Practice Address - Country:US
Practice Address - Phone:808-491-5953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-22
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health