1255401329 NPI number — DR. LYNN K. FUJIMOTO DMD

Table of content: JOEL CHATTERTON (NPI 1689134447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255401329 NPI number — DR. LYNN K. FUJIMOTO DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FUJIMOTO
Provider First Name:
LYNN
Provider Middle Name:
K.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

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:
1255401329
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
850 KAMEHAMEHA HWY STE 215
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEARL CITY
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96782-2603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-455-3888
Provider Business Mailing Address Fax Number:
808-455-6180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 KAMEHAMEHA HWY STE 215
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEARL CITY
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96782-2603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-455-3888
Provider Business Practice Location Address Fax Number:
808-455-6180
Provider Enumeration Date:
11/08/2006

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: 1223P0221X , with the licence number:  DT 1116 , 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: 1116-01 . This is a "HDS PROVIDER NO." identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 5433-8 . This is a "HMSA PROVIDER NO." identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 519639-01 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 090020 . This is a "UNITED CONCORDIA NO." identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".