Provider Demographics
NPI:1598869208
Name:DENNIS ISSEI MAEHARA MD INC
Entity Type:Organization
Organization Name:DENNIS ISSEI MAEHARA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:I
Authorized Official - Last Name:MAEHARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-955-3937
Mailing Address - Street 1:1441 KAPIOLANI BLVD
Mailing Address - Street 2:STE 1419
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4402
Mailing Address - Country:US
Mailing Address - Phone:808-955-3937
Mailing Address - Fax:808-955-3930
Practice Address - Street 1:1441 KAPIOLANI BLVD
Practice Address - Street 2:STE 1419
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4402
Practice Address - Country:US
Practice Address - Phone:808-955-3937
Practice Address - Fax:808-955-3930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 2131207W00000X
HIMD 11924207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI530966-01Medicaid
HI530966-02Medicaid
HI032240-01Medicaid
HI032240-02Medicaid
H45585Medicare UPIN
HI032240-01Medicaid
HI530966-01Medicaid
HI032240-02Medicaid