Provider Demographics
NPI:1811495336
Name:JILL KANEMARU-HWANG DDS LLC
Entity type:Organization
Organization Name:JILL KANEMARU-HWANG DDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:KANEMARU-HWANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-622-4354
Mailing Address - Street 1:410 KILANI AVE STE 221
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-1844
Mailing Address - Country:US
Mailing Address - Phone:808-622-4354
Mailing Address - Fax:
Practice Address - Street 1:410 KILANI AVE STE 221
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-1844
Practice Address - Country:US
Practice Address - Phone:808-622-4354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI24311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty