Provider Demographics
NPI:1871157628
Name:ALA MOANA WALK-IN MEDICAL CLINIC, INC
Entity type:Organization
Organization Name:ALA MOANA WALK-IN MEDICAL CLINIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAE HWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-498-7913
Mailing Address - Street 1:3033 ALA ILIMA ST APT 402
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-2762
Mailing Address - Country:US
Mailing Address - Phone:808-256-1250
Mailing Address - Fax:
Practice Address - Street 1:410 ATKINSON DR.
Practice Address - Street 2:LEVEL 3
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814
Practice Address - Country:US
Practice Address - Phone:808-498-7913
Practice Address - Fax:808-748-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-26
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty