Provider Demographics
NPI:1114155413
Name:KAPOLEI FAMILY DENTAL CORPORATION
Entity Type:Organization
Organization Name:KAPOLEI FAMILY DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WEN-JOU
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-674-8000
Mailing Address - Street 1:1001 KAMOKILA BLVD
Mailing Address - Street 2:# 109 KAPOLEI BLDG
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2014
Mailing Address - Country:US
Mailing Address - Phone:808-674-8000
Mailing Address - Fax:808-674-8607
Practice Address - Street 1:1001 KAMOKILA BLVD
Practice Address - Street 2:# 109 KAPOLEI BLDG
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2014
Practice Address - Country:US
Practice Address - Phone:808-674-8000
Practice Address - Fax:808-674-8607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-1703122300000X
HIDT-1850122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty