12D2125620 CLIA NUMBER - FIVE MOUNTAINS HAWAII INC DBA KIPUKA O KE OLA

Laboratory Demographics

  • CLIA Code: 12D2125620
  • Facility Name: FIVE MOUNTAINS HAWAII INC DBA KIPUKA O KE OLA
  • Facility Address: 64-1035 MAMALAHOA HWY SUITE F
    KAMUELA, HI
    ZIP 96743
  • Facility Phone: 808 885-5900
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: DR. KENNETH M. RIFF
  • NPI Number: 1215359989
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 12D2125620
LAB Type Rural Health Clinic
Facility Name FIVE MOUNTAINS HAWAII INC DBA KIPUKA O KE OLA
Street 64-1035 MAMALAHOA HWY SUITE F
City KAMUELA
State HI
ZIP 96743
Phone 808 885-5900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/10/2025
Certificate Expiration Date 2/9/2027
Facility Type Rural Health Clinic
Lab Director DR. KENNETH M. RIFF

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