Provider Demographics
NPI:1013607696
Name:KIYONO, BERNADETTE LEIMOMI (RDH)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:LEIMOMI
Last Name:KIYONO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-580 ANEKO PL
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-1877
Mailing Address - Country:US
Mailing Address - Phone:808-799-2623
Mailing Address - Fax:
Practice Address - Street 1:41-1347 KALANIANAOLE HWY STE A
Practice Address - Street 2:
Practice Address - City:WAIMANALO
Practice Address - State:HI
Practice Address - Zip Code:96795-1297
Practice Address - Country:US
Practice Address - Phone:808-259-5466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDH-1149124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist