Provider Demographics
NPI:1710136874
Name:ICHIRIU, KEVIN (DDS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:ICHIRIU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-211 PALI MOMI ST
Mailing Address - Street 2:STE. 737
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:98-211 PALI MOMI ST
Practice Address - Street 2:STE. 737
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4301
Practice Address - Country:US
Practice Address - Phone:808-487-1554
Practice Address - Fax:808-487-1556
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-13
Last Update Date:2008-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI013131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice