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500 Ala Moana Blvd Ste 6d Honolulu HI 96813 | |
| (808) 777-4000 | |
| (808) 465-2505 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 500 Ala Moana Blvd Ste 6d, Honolulu, Hawaii |
| Authorized Official Name and Position | Robert Joseph Walker (PROGRAM DIRECTOR) |
| Authorized Official Contact | 8087774000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
500 Ala Moana Blvd Ste 6d Honolulu HI 96813-4984 Ph: (808) 777-4000 | 500 Ala Moana Blvd Ste 6d Honolulu HI 96813 Ph: (808) 777-4000 |
| NPI Number | 1376031013 |
|---|---|
| Provider Enumeration Date | 04/27/2018 |
| Last Update Date | 10/02/2019 |
| Medicare PECOS PAC ID | 1850647876 |
|---|---|
| Medicare Enrollment ID | O20180705002258 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376031013 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| 261QM2500X | Clinic/center - Medical Specialty | (* (Not Available)) | Secondary |
| Provider Name | Anthony F Magliulo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558471342 PECOS PAC ID: 6608801774 Enrollment ID: I20050928000610 |
| Provider Name | Maria E Wilson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720344906 PECOS PAC ID: 6103833264 Enrollment ID: I20060314000647 |
| Provider Name | Julie A Asari |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174520431 PECOS PAC ID: 6709949936 Enrollment ID: I20090409000215 |
| Provider Name | Siuling Y Kwan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871682989 PECOS PAC ID: 5395873517 Enrollment ID: I20100510000390 |
| Provider Name | Robin Matsukawa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568668325 PECOS PAC ID: 1355474560 Enrollment ID: I20100809000150 |
| Provider Name | Steven Mc Lum |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790874972 PECOS PAC ID: 8729032651 Enrollment ID: I20101102000696 |
| Provider Name | Alice Deutsch Mendykowski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083959621 PECOS PAC ID: 3173769247 Enrollment ID: I20130415000465 |
| Provider Name | Dawn Harada |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1326487562 PECOS PAC ID: 6709028301 Enrollment ID: I20130812000178 |
| Provider Name | Amanda J Mcfarland |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1669517546 PECOS PAC ID: 3375447113 Enrollment ID: I20140328000140 |
| Provider Name | Eloise M Guckelberger |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1750781589 PECOS PAC ID: 1759503576 Enrollment ID: I20141112000172 |
| Provider Name | Ryan K Tenn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013388735 PECOS PAC ID: 7012258007 Enrollment ID: I20190329002199 |
| Provider Name | Nataliya V Holmes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154785368 PECOS PAC ID: 2163756065 Enrollment ID: I20190626003473 |
| Provider Name | Kimberly Iese |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285824573 PECOS PAC ID: 8123107414 Enrollment ID: I20200626002099 |
| Provider Name | Chloe Bonnie Hasegawa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093326530 PECOS PAC ID: 1557781978 Enrollment ID: I20201022004163 |
| Provider Name | Maggie Abernathy Baxley |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1508464926 PECOS PAC ID: 5890105753 Enrollment ID: I20201104000095 |
| Provider Name | Boram Sunny Lee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497106231 PECOS PAC ID: 0042546814 Enrollment ID: I20220603002147 |
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