Provider Demographics
NPI:1972829158
Name:KLOSTERMAN, LISA KAI (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:KAI
Last Name:KLOSTERMAN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MIYUKI
Other - Last Name:KAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:PO BOX 8583
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96830-0583
Mailing Address - Country:US
Mailing Address - Phone:808-216-8673
Mailing Address - Fax:
Practice Address - Street 1:934 PUNAHOU ST STE E
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-2522
Practice Address - Country:US
Practice Address - Phone:808-777-2377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2041951223X0400X
CA579321223X0400X
TX308561223X0400X
HI31501223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics