Provider Demographics
NPI:1013045954
Name:IKENO, JASON HANJI (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:HANJI
Last Name:IKENO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-216 FARRINGTON HWY
Mailing Address - Street 2:B2-309
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-1922
Mailing Address - Country:US
Mailing Address - Phone:808-676-1520
Mailing Address - Fax:808-676-1921
Practice Address - Street 1:94-216 FARRINGTON HWY
Practice Address - Street 2:B2-309
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1922
Practice Address - Country:US
Practice Address - Phone:808-676-1520
Practice Address - Fax:808-676-1921
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-18191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI24459501Medicaid