Provider Demographics
NPI:1952449464
Name:AWAMURA, KYOKO (DDS MSD)
Entity Type:Individual
Prefix:DR
First Name:KYOKO
Middle Name:
Last Name:AWAMURA
Suffix:
Gender:F
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81-6627 MAMALAHOA HWY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-8180
Mailing Address - Country:US
Mailing Address - Phone:808-323-8005
Mailing Address - Fax:808-323-2255
Practice Address - Street 1:81-6627 MAMALAHOA HWY
Practice Address - Street 2:SUITE 106
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-8180
Practice Address - Country:US
Practice Address - Phone:808-323-8005
Practice Address - Fax:808-323-2255
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA62411223P0221X, 1223X0400X
HICSDT-601223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI686701Medicaid
WA5022918Medicaid