| Kukui Lifestyle Medicine Clinic | |
|
82-6066 Mamalahoa Hwy Ste 14 Captain Cook HI 96704-8204 | |
| (808) 825-6557 | |
| (808) 731-6511 |
| Full Name | Kukui Lifestyle Medicine Clinic |
|---|---|
| Speciality | Internal Medicine |
| Location | 82-6066 Mamalahoa Hwy Ste 14, Captain Cook, Hawaii |
| Authorized Official Name and Position | Leon Matsuo (OWNER) |
| Authorized Official Contact | 8083820754 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kukui Lifestyle Medicine Clinic Po Box 312 Captain Cook HI 96704-0312 Ph: (808) 825-6557 | Kukui Lifestyle Medicine Clinic 82-6066 Mamalahoa Hwy Ste 14 Captain Cook HI 96704-8204 Ph: (808) 825-6557 |
| NPI Number | 1073019162 |
|---|---|
| Provider Enumeration Date | 04/05/2018 |
| Last Update Date | 03/01/2024 |
| Medicare PECOS PAC ID | 6305100736 |
|---|---|
| Medicare Enrollment ID | O20180510001009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073019162 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MD16101 (Hawaii) | Primary |
| Provider Name | Jodi Leslie Matsuo |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1720582869 PECOS PAC ID: 5193741411 Enrollment ID: I20051017000554 |
| Provider Name | Leon P Matsuo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235334947 PECOS PAC ID: 0547438947 Enrollment ID: I20110802000814 |
West Hawaii Community Health Center, Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 83-5360 Mamalahoa Hwy, Captain Cook, HI 96704 Phone: 808-326-3878 | |
Ohana Kauka, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 82-6123 Mamalahoa Hwy, Top Floor, Captain Cook, HI 96704 Phone: 808-323-8200 Fax: 808-323-8400 |