Provider Demographics
NPI:1518379767
Name:MIYASAKI, DAVID KEN (DMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:KEN
Last Name:MIYASAKI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 BETHEL ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2207
Mailing Address - Country:US
Mailing Address - Phone:808-533-0000
Mailing Address - Fax:
Practice Address - Street 1:1139 BETHEL ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2207
Practice Address - Country:US
Practice Address - Phone:808-533-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI25301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice