| Kailua Primary Care | |
|
328 Uluniu St Ste 103 Kailua HI 96734-2542 | |
| (808) 263-3020 | |
| (808) 762-1586 |
| Full Name | Kailua Primary Care |
|---|---|
| Speciality | Family Medicine |
| Location | 328 Uluniu St Ste 103, Kailua, Hawaii |
| Authorized Official Name and Position | Sarah Canyon (OWNER) |
| Authorized Official Contact | 8086798518 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kailua Primary Care 328 Uluniu St Ste 103 Kailua HI 96734-2542 | Kailua Primary Care 328 Uluniu St Ste 103 Kailua HI 96734-2542 Ph: (808) 263-3020 |
| NPI Number | 1295341550 |
|---|---|
| Provider Enumeration Date | 09/21/2020 |
| Last Update Date | 01/03/2022 |
| Certification Date | 01/03/2022 |
| Medicare PECOS PAC ID | 3476963596 |
|---|---|
| Medicare Enrollment ID | O20201030002355 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295341550 | NPI | - | NPPES |
| 814873 | Medicaid | HI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (NU) | Primary |
| Provider Name | Sarah J Canyon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588082259 PECOS PAC ID: 6002185725 Enrollment ID: I20170711003290 |
| Provider Name | Alyssa Los |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1699420380 PECOS PAC ID: 9638514193 Enrollment ID: I20240224000029 |
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