Provider Demographics
NPI:1699329839
Name:MALAMA KIDNEY CENTER, LLC
Entity type:Organization
Organization Name:MALAMA KIDNEY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIMOMURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-942-1852
Mailing Address - Street 1:1357 KAPIOLANI BLVD STE 1460
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4509
Mailing Address - Country:US
Mailing Address - Phone:808-942-1852
Mailing Address - Fax:808-943-8732
Practice Address - Street 1:1357 KAPIOLANI BLVD STE 1460
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4509
Practice Address - Country:US
Practice Address - Phone:808-942-1852
Practice Address - Fax:808-943-8732
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PMAG CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-25
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Single Specialty