Provider Demographics
NPI:1184097677
Name:NALU DENTAL LLC
Entity type:Organization
Organization Name:NALU DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BOKI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-658-0468
Mailing Address - Street 1:28 KAMOI ST
Mailing Address - Street 2:SUITE #200
Mailing Address - City:KAUNAKAKAI
Mailing Address - State:HI
Mailing Address - Zip Code:96748-0841
Mailing Address - Country:US
Mailing Address - Phone:808-553-5118
Mailing Address - Fax:808-553-3477
Practice Address - Street 1:28 KAMOI ST
Practice Address - Street 2:SUITE #200
Practice Address - City:KAUNAKAKAI
Practice Address - State:HI
Practice Address - Zip Code:96748-0841
Practice Address - Country:US
Practice Address - Phone:808-553-5118
Practice Address - Fax:808-553-3477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-2406122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI686264Medicaid