Provider Demographics
NPI:1992936140
Name:KUHIO DENTAL GROUP
Entity type:Organization
Organization Name:KUHIO DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-959-3433
Mailing Address - Street 1:111 E. PUAINAKO ST.,
Mailing Address - Street 2:UNIT #104
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720
Mailing Address - Country:US
Mailing Address - Phone:808-959-3433
Mailing Address - Fax:808-959-3675
Practice Address - Street 1:111 E PUAINAKO ST UNIT 104
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5288
Practice Address - Country:US
Practice Address - Phone:808-959-3433
Practice Address - Fax:808-959-3675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT 1617122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00L063804OtherHAWAII MEDICAL SERVICES ASSOCIATION
HI61617OtherHAWAII DENTAL SERVICES
HI537730Medicaid