Provider Demographics
NPI:1366570178
Name:ZUKERAN, KEITH H (DDS)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:H
Last Name:ZUKERAN
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 1:1150 S. KING ST.
Mailing Address - Street 2:SUITE 607
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814
Mailing Address - Country:US
Mailing Address - Phone:808-596-2400
Mailing Address - Fax:
Practice Address - Street 1:1150 S KING ST
Practice Address - Street 2:SUITE 607
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1922
Practice Address - Country:US
Practice Address - Phone:808-596-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-16961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1696OtherHDS
HIC7959-4OtherHMSA