Provider Demographics
NPI:1306955000
Name:ISHIHARA, KERRY S (DDS)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:S
Last Name:ISHIHARA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 KILANI AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-2044
Mailing Address - Country:US
Mailing Address - Phone:808-621-8281
Mailing Address - Fax:808-621-8281
Practice Address - Street 1:810 KILANI AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-2044
Practice Address - Country:US
Practice Address - Phone:808-621-8281
Practice Address - Fax:808-621-8281
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHI13331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02828801Medicaid