Provider Demographics
NPI:1306972476
Name:M. K. DENTAL CARE LLC
Entity type:Organization
Organization Name:M. K. DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER-MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:C W
Authorized Official - Last Name:KAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-941-1464
Mailing Address - Street 1:1773 S KING ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-2183
Mailing Address - Country:US
Mailing Address - Phone:808-941-1464
Mailing Address - Fax:
Practice Address - Street 1:1773 S KING ST
Practice Address - Street 2:SUITE 201
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-2183
Practice Address - Country:US
Practice Address - Phone:808-941-1464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI333261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI8630-6OtherHMSA
HI333OtherHAWAII DENTAL SERVICE