Provider Demographics
NPI:1780763896
Name:KOGA, KEITH M (DDS)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:M
Last Name:KOGA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:98-211 PALI MOMI ST
Mailing Address - Street 2:SUITE 725
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4301
Mailing Address - Country:US
Mailing Address - Phone:808-484-0600
Mailing Address - Fax:808-484-0837
Practice Address - Street 1:98-211 PALI MOMI ST
Practice Address - Street 2:SUITE 725
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4301
Practice Address - Country:US
Practice Address - Phone:808-484-0600
Practice Address - Fax:808-484-0837
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT16911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice