Provider Demographics
NPI:1619649498
Name:MAH, KIMBERLY (DDS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MAH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E PUAINAKO ST STE 104A
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5295
Mailing Address - Country:US
Mailing Address - Phone:808-959-3433
Mailing Address - Fax:808-959-3675
Practice Address - Street 1:111 E PUAINAKO ST STE 104A
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5295
Practice Address - Country:US
Practice Address - Phone:808-959-3433
Practice Address - Fax:808-959-3675
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2940122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist