1336113125 NPI number — DR. JAMES M SAGAWA DMD

Table of content: DR. JAMES M SAGAWA DMD (NPI 1336113125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336113125 NPI number — DR. JAMES M SAGAWA DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAGAWA
Provider First Name:
JAMES
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

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:
1336113125
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 630117
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANAI CITY
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96763-0117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-565-6418
Provider Business Mailing Address Fax Number:
808-565-6742

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
730 LANAI AVENUE
Provider Second Line Business Practice Location Address:
SUITE #101
Provider Business Practice Location Address City Name:
LANAI CITY
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96763-0117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-565-6418
Provider Business Practice Location Address Fax Number:
808-565-6418
Provider Enumeration Date:
02/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  740 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: D4167 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: B210977 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 24642101 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9740 . This is a "HDS" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 47198 . This is a "BCBS" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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