12D1033697 CLIA NUMBER - KAISER PERMANENTE MAUI LANI MEDICAL OFC PPMP

Laboratory Demographics

  • CLIA Code: 12D1033697
  • Facility Name: KAISER PERMANENTE MAUI LANI MEDICAL OFC PPMP
  • Facility Address: 55 MAUI LANI PARKWAY
    WAILUKU, HI
    ZIP 96793
  • Facility Phone: 808 243-6171
  • Facility Type: Health Main. Organization
  • Facility Type: Microscopy
  • Lab Director: DR. DAVID M. BACCHUS
  • NPI Number: 1275985111
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 12D1033697
LAB Type Health Main. Organization
Facility Name KAISER PERMANENTE MAUI LANI MEDICAL OFC PPMP
Street 55 MAUI LANI PARKWAY
City WAILUKU
State HI
ZIP 96793
Phone 808 243-6171
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 11/15/2024
Certificate Expiration Date 11/14/2026
Facility Type Health Main. Organization
Lab Director DR. DAVID M. BACCHUS

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This page was last updated on: 9/29/2025