Provider Demographics
NPI:1619453180
Name:ITOGA, DENNIS PAUL
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:PAUL
Last Name:ITOGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 KAPIOLANI BLVD APT 2908
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-6045
Mailing Address - Country:US
Mailing Address - Phone:808-352-7911
Mailing Address - Fax:
Practice Address - Street 1:550 KUNEHI ST APT 205
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2069
Practice Address - Country:US
Practice Address - Phone:808-674-6641
Practice Address - Fax:808-504-5442
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY1716103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI26-4490603Medicaid