| Ke Ola Pono Ohana Family Medicine Clinic, Llc | |
|
99-128 Aiea Heights Dr Suite 505 Aiea HI 96701-3925 | |
| (808) 536-0300 | |
| (808) 536-0320 |
| Full Name | Ke Ola Pono Ohana Family Medicine Clinic, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 99-128 Aiea Heights Dr, Aiea, Hawaii |
| Authorized Official Name and Position | Melanie M Payanal (CEO) |
| Authorized Official Contact | 8085360300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ke Ola Pono Ohana Family Medicine Clinic, Llc 848 S Beretania St Suite 400 Honolulu HI 96813-2551 Ph: (808) 536-0300 | Ke Ola Pono Ohana Family Medicine Clinic, Llc 99-128 Aiea Heights Dr Suite 505 Aiea HI 96701-3925 Ph: (808) 536-0300 |
| NPI Number | 1689056699 |
|---|---|
| Provider Enumeration Date | 06/25/2015 |
| Last Update Date | 08/17/2015 |
| Medicare PECOS PAC ID | 1254641442 |
|---|---|
| Medicare Enrollment ID | O20151029002006 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689056699 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MD - 18089 (Hawaii) | Primary |
| Provider Name | Melanie M Payanal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164782371 PECOS PAC ID: 4183934383 Enrollment ID: I20151110000533 |
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