Provider Demographics
NPI:1255401329
Name:FUJIMOTO, LYNN K (DMD)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:K
Last Name:FUJIMOTO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 KAMEHAMEHA HWY STE 215
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:808-455-3888
Mailing Address - Fax:808-455-6180
Practice Address - Street 1:850 KAMEHAMEHA HWY STE 215
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:808-455-3888
Practice Address - Fax:808-455-6180
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT 11161223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1116-01OtherHDS PROVIDER NO.
HI5433-8OtherHMSA PROVIDER NO.
HI519639-01Medicaid
HI090020OtherUNITED CONCORDIA NO.