Provider Demographics
NPI:1497151849
Name:HAWAII DENTAL CLINIC KAHALA HARADA LLC
Entity Type:Organization
Organization Name:HAWAII DENTAL CLINIC KAHALA HARADA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:WH
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-538-6522
Mailing Address - Street 1:50 S BERETANIA ST
Mailing Address - Street 2:C-117B
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2208
Mailing Address - Country:US
Mailing Address - Phone:808-538-6522
Mailing Address - Fax:
Practice Address - Street 1:4211 WAIALAE AVE # G22
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5319
Practice Address - Country:US
Practice Address - Phone:808-735-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT2521122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty