Provider Demographics
NPI:1780197871
Name:LUM, CAITLIN SAHARA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:SAHARA
Last Name:LUM
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:PO BOX 160904
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-0921
Mailing Address - Country:US
Mailing Address - Phone:808-732-2822
Mailing Address - Fax:808-732-2821
Practice Address - Street 1:850 KAMEHAMEHA HWY STE 155
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2657
Practice Address - Country:US
Practice Address - Phone:808-456-5005
Practice Address - Fax:808-454-2569
Is Sole Proprietor?:No
Enumeration Date:2017-11-10
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI27281223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice