12D2177452 CLIA NUMBER - MAUI FAMILY MEDICINE

Laboratory Demographics

CLIA Number: 12D2177452

Facility Name: MAUI FAMILY MEDICINE

Facility Address:
169 MAA ST, SUITE A
KAHULUI, HI
ZIP 96732
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Facility Phone Number: 808 727-1920

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1710511993

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	12D2177452
LAB Type	Practitioner Other
Facility Name	MAUI FAMILY MEDICINE
Street	169 MAA ST, SUITE A
City	KAHULUI
State	HI
ZIP	96732
Phone	808 727-1920
CertificateType	4
CertificateEffectiveDate	1/10/2024
CertificateExpirationDate	1/9/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024