Organization Name: | KEIKI KORNER PEDIATRICS |
NPI Number: | 1205112109 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LEILA M AGULLANA (OWNER) |
Mailing Address: | 1001 Kamokila Blvd Suite 197 Kapolei |
State: | HI US |
Postal Code: | 967072014 |
Phone Number: | 8086749600 |
Fax Number: | 8086749700 |
NPI Enumeration Date: | 10/25/2011 |
NPI Last Update Date: | 10/25/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 12344 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | HI |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |