12D2235207 CLIA NUMBER - KUKUI LIFESTYLE MEDICINE CLINIC

Laboratory Demographics

  • CLIA Code: 12D2235207
  • Facility Name: KUKUI LIFESTYLE MEDICINE CLINIC
  • Facility Address: 82-6066 MAMALAHOA HWY, STE 14
    CAPTAIN COOK, HI
    ZIP 96704
  • Facility Phone: 808 825-6557
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. LEON MATSUO
  • NPI Number: 1073019162
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 12D2235207
LAB Type Physician Office
Facility Name KUKUI LIFESTYLE MEDICINE CLINIC
Street 82-6066 MAMALAHOA HWY, STE 14
City CAPTAIN COOK
State HI
ZIP 96704
Phone 808 825-6557
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/7/2025
Certificate Expiration Date 9/6/2027
Facility Type Physician Office
Lab Director DR. LEON MATSUO

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