1487798005 NPI number — DR. STAPHE T FUJIMOTO DDS

Table of content: DR. STAPHE T FUJIMOTO DDS (NPI 1487798005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487798005 NPI number — DR. STAPHE T FUJIMOTO DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FUJIMOTO
Provider First Name:
STAPHE
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
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:
1487798005
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:
95720 LANIKUHANA AVENUE
Provider Second Line Business Mailing Address:
SUITE 230
Provider Business Mailing Address City Name:
MILILANI
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96789
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-625-6333
Provider Business Mailing Address Fax Number:
808-625-6640

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
95720 LANIKUHANA AVENUE
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
MILILANI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96789
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-625-6333
Provider Business Practice Location Address Fax Number:
808-625-6640
Provider Enumeration Date:
02/16/2007

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: 122300000X , with the licence number:  1386 , 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: C21406 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 805457 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".




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