Provider Demographics
NPI:1043869043
Name:WAI KAHALA DENTISTRY LLC
Entity Type:Organization
Organization Name:WAI KAHALA DENTISTRY LLC
Other - Org Name:WAI KAHALA DENTISTRY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:TAKAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-732-1424
Mailing Address - Street 1:4211 WAIALAE AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5312
Mailing Address - Country:US
Mailing Address - Phone:808-732-1424
Mailing Address - Fax:
Practice Address - Street 1:4211 WAIALAE AVE STE 210
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5312
Practice Address - Country:US
Practice Address - Phone:808-732-1424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-11
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty