Provider Demographics
NPI:1902779101
Name:DUARTE, KEOKI KAMUELA SR
Entity type:Individual
Prefix:MR
First Name:KEOKI
Middle Name:KAMUELA
Last Name:DUARTE
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87-138 KULAKUMU PL
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-3366
Mailing Address - Country:US
Mailing Address - Phone:808-492-9003
Mailing Address - Fax:
Practice Address - Street 1:87-138 KULAKUMU PL
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-3366
Practice Address - Country:US
Practice Address - Phone:808-492-9003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)