Provider Demographics
NPI:1770116790
Name:SOH PARTNERSHIP OF HAWAII
Entity type:Organization
Organization Name:SOH PARTNERSHIP OF HAWAII
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAMSON
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:217-821-7960
Mailing Address - Street 1:930 VALKENBURGH ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-3912
Mailing Address - Country:US
Mailing Address - Phone:808-261-4696
Mailing Address - Fax:
Practice Address - Street 1:930 VALKENBURGH ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-3912
Practice Address - Country:US
Practice Address - Phone:808-261-4696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOOK ORTHODONTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-18
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIB53837401Medicaid