1184097677 NPI number — NALU DENTAL LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184097677 NPI number — NALU DENTAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NALU DENTAL LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184097677
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28 KAMOI ST
Provider Second Line Business Mailing Address:
SUITE #200
Provider Business Mailing Address City Name:
KAUNAKAKAI
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96748-0841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-553-5118
Provider Business Mailing Address Fax Number:
808-553-3477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28 KAMOI ST
Provider Second Line Business Practice Location Address:
SUITE #200
Provider Business Practice Location Address City Name:
KAUNAKAKAI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96748-0841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-553-5118
Provider Business Practice Location Address Fax Number:
808-553-3477
Provider Enumeration Date:
11/05/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CHUNG
Authorized Official First Name:
BOKI
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
808-658-0468

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DT-2406 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 686264 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com