Provider Demographics
NPI:1932695327
Name:ROBERT K. AZAMA, D.M.D.
Entity Type:Organization
Organization Name:ROBERT K. AZAMA, D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:AZAMA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-455-8577
Mailing Address - Street 1:850 KAMEHAMEHA HWY STE 115
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2603
Mailing Address - Country:US
Mailing Address - Phone:808-455-8577
Mailing Address - Fax:
Practice Address - Street 1:850 KAMEHAMEHA HWY STE 115
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2603
Practice Address - Country:US
Practice Address - Phone:808-455-8577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1072261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04141401Medicaid