Provider Demographics
NPI:1184848350
Name:MASUNAGA, MARK ISAMI (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ISAMI
Last Name:MASUNAGA
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:5225B KUAIWI PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821
Mailing Address - Country:US
Mailing Address - Phone:808-373-7455
Mailing Address - Fax:808-373-7422
Practice Address - Street 1:766225 KUAKINI HWY
Practice Address - Street 2:SUITE B101
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740
Practice Address - Country:US
Practice Address - Phone:808-326-7333
Practice Address - Fax:808-326-7573
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIPT14311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics