Provider Demographics
NPI:1003308271
Name:IVAN CHUAH LLC
Entity Type:Organization
Organization Name:IVAN CHUAH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-246-4881
Mailing Address - Street 1:4347 RICE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766
Mailing Address - Country:US
Mailing Address - Phone:808-246-4881
Mailing Address - Fax:808-246-4882
Practice Address - Street 1:4347 RICE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766
Practice Address - Country:US
Practice Address - Phone:808-246-4881
Practice Address - Fax:808-246-4882
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IVAN CHUAH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-2458122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI68781602Medicaid