Provider Demographics
NPI:1649488404
Name:YAMAMOTO, JOSEPH HIROUEMON (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:HIROUEMON
Last Name:YAMAMOTO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 N KING ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-4527
Mailing Address - Country:US
Mailing Address - Phone:808-848-0708
Mailing Address - Fax:808-848-0777
Practice Address - Street 1:2122 N KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4527
Practice Address - Country:US
Practice Address - Phone:808-848-0708
Practice Address - Fax:808-848-0777
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI9471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI4567-4Medicaid