Provider Demographics
NPI:1700979531
Name:KE OLA MAMO
Entity type:Organization
Organization Name:KE OLA MAMO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:SHAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFANAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-440-6852
Mailing Address - Street 1:680 IWILEI RD STE 500
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-5389
Mailing Address - Country:US
Mailing Address - Phone:808-440-6852
Mailing Address - Fax:808-440-6878
Practice Address - Street 1:321 N KUAKINI ST STE 308
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2360
Practice Address - Country:US
Practice Address - Phone:808-440-6852
Practice Address - Fax:808-440-6878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI100834Medicare ID - Type Unspecified