Provider Demographics
NPI:1497028138
Name:KAU, AMMON (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMMON
Middle Name:
Last Name:KAU
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 1:275 PONAHAWAI ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3074
Mailing Address - Country:US
Mailing Address - Phone:808-961-6704
Mailing Address - Fax:
Practice Address - Street 1:275 PONAHAWAI ST
Practice Address - Street 2:SUITE 204
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3074
Practice Address - Country:US
Practice Address - Phone:808-961-6704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2454122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist