Provider Demographics
NPI:1699009977
Name:MARK Y. SHIMAO, DDS, INC.
Entity Type:Organization
Organization Name:MARK Y. SHIMAO, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:YUJI
Authorized Official - Last Name:SHIMAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-689-6900
Mailing Address - Street 1:91-902 FORT WEAVER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2261
Mailing Address - Country:US
Mailing Address - Phone:808-689-6900
Mailing Address - Fax:808-689-8330
Practice Address - Street 1:91-902 FORT WEAVER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2261
Practice Address - Country:US
Practice Address - Phone:808-689-6900
Practice Address - Fax:808-689-8330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-19
Last Update Date:2009-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI16941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI069761 01Medicaid