Provider Demographics
NPI:1336405091
Name:KEN M YAMASHIRO DDS INC
Entity Type:Organization
Organization Name:KEN M YAMASHIRO DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:YAMASHIRO
Authorized Official - Suffix:
Authorized Official - Credentials:BA, DDS
Authorized Official - Phone:808-961-3911
Mailing Address - Street 1:1142 KINOOLE ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4132
Mailing Address - Country:US
Mailing Address - Phone:808-961-3911
Mailing Address - Fax:808-933-9293
Practice Address - Street 1:1142 KINOOLE ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4132
Practice Address - Country:US
Practice Address - Phone:808-961-3911
Practice Address - Fax:808-933-9293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty