1992936140 NPI number — KUHIO DENTAL GROUP

Table of content: (NPI 1992936140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992936140 NPI number — KUHIO DENTAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KUHIO DENTAL GROUP
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:
1992936140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 E. PUAINAKO ST.,
Provider Second Line Business Mailing Address:
UNIT #104
Provider Business Mailing Address City Name:
HILO
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-959-3433
Provider Business Mailing Address Fax Number:
808-959-3675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 E PUAINAKO ST UNIT 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILO
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96720-5288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-959-3433
Provider Business Practice Location Address Fax Number:
808-959-3675
Provider Enumeration Date:
08/06/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MAH
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
808-959-3433

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DT 1617 , 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: 00L063804 . This is a "HAWAII MEDICAL SERVICES ASSOCIATION" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 61617 . This is a "HAWAII DENTAL SERVICES" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 537730 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".