Provider Demographics
NPI:1346457116
Name:MOURI, MICHAEL PATRICK (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PATRICK
Last Name:MOURI
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1744 LILIHA ST STE 207
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-3115
Mailing Address - Country:US
Mailing Address - Phone:469-585-1455
Mailing Address - Fax:
Practice Address - Street 1:1744 LILIHA ST
Practice Address - Street 2:SUITE 207
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3115
Practice Address - Country:US
Practice Address - Phone:808-536-6073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18734122300000X, 171000000X, 171100000X, 207Q00000X, 209800000X, 207P00000X
HIM8095122300000X, 207P00000X, 207Q00000X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No122300000XDental ProvidersDentist
No171000000XOther Service ProvidersMilitary Health Care Provider
No171100000XOther Service ProvidersAcupuncturist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No209800000XAllopathic & Osteopathic PhysiciansLegal Medicine