Provider Demographics
NPI:1063640456
Name:ITO, BERWYN YOSHIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:BERWYN
Middle Name:YOSHIO
Last Name:ITO
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 1:1600 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3801
Mailing Address - Country:US
Mailing Address - Phone:808-947-8888
Mailing Address - Fax:808-946-6638
Practice Address - Street 1:1600 KAPIOLANI BLVD
Practice Address - Street 2:SUITE 1400
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3801
Practice Address - Country:US
Practice Address - Phone:808-947-8888
Practice Address - Fax:808-946-6638
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT 18091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIDT 1809OtherHAWAII STATE LICENSE