Provider Demographics
NPI:1689123200
Name:KUHIO PEDIATRIC DENTAL LLC
Entity Type:Organization
Organization Name:KUHIO PEDIATRIC DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:P
Authorized Official - Last Name:JAUREQUI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-378-4869
Mailing Address - Street 1:3-3359 KUHIO HWY
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-1031
Mailing Address - Country:US
Mailing Address - Phone:808-378-4869
Mailing Address - Fax:808-320-3329
Practice Address - Street 1:3-3359 KUHIO HWY
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1061
Practice Address - Country:US
Practice Address - Phone:808-378-4869
Practice Address - Fax:808-320-3329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty