Provider Demographics
NPI:1063544831
Name:KAIMUKI CENTER FOR DENTISTRY
Entity type:Organization
Organization Name:KAIMUKI CENTER FOR DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:K B
Authorized Official - Last Name:TOM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-737-9032
Mailing Address - Street 1:3221 WAIALAE AVE
Mailing Address - Street 2:STE 376
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5842
Mailing Address - Country:US
Mailing Address - Phone:808-737-9032
Mailing Address - Fax:808-737-0290
Practice Address - Street 1:3221 WAIALAE AVE
Practice Address - Street 2:376
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5842
Practice Address - Country:US
Practice Address - Phone:808-737-9032
Practice Address - Fax:808-737-0290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1192122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty