Provider Demographics
NPI:1801924659
Name:HARUKI, TODD K (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:K
Last Name:HARUKI
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 YOUNG ST STE 312
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1609
Mailing Address - Country:US
Mailing Address - Phone:808-585-8455
Mailing Address - Fax:808-585-8458
Practice Address - Street 1:1060 YOUNG ST STE 312
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1609
Practice Address - Country:US
Practice Address - Phone:808-585-8455
Practice Address - Fax:808-585-8458
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-18151223S0112X
HIMD-10737204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HID21682-2OtherHMSA DENTAL PIN
HI741204OtherUNITED CONCORDIA PIN
HID22065-9OtherHMSA MEDICAL PIN
HI1815OtherHAWAII DENTAL SERVICE PIN
HI00C0220659OtherHMSA QUEST PIN
HI52286401Medicaid
HI990358549OtherINSURANCE PIN
HIC22065-1OtherHMSA MEDICAL PIN
HI00C0220651OtherHMSA QUEST PIN
HIC21682-4OtherHMSA DENTAL PIN
HIG73735Medicare UPIN
HI53127Medicare ID - Type Unspecified