Provider Demographics
NPI:1700295581
Name:GOO-RAHTZ, KAIMANA MEW LUNG (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:KAIMANA
Middle Name:MEW LUNG
Last Name:GOO-RAHTZ
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 PAPALOA RD
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-1454
Mailing Address - Country:US
Mailing Address - Phone:808-823-8707
Mailing Address - Fax:
Practice Address - Street 1:437 PAPALOA RD
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1454
Practice Address - Country:US
Practice Address - Phone:808-823-8707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT- 25311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice