MEDICARE: DR. RUSSELL HIROSHI MASUNAGA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D-1711	HI

General Provider Information

NPI Number	:	1588661847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL HIROSHI MASUNAGA DDS

Provider Business Mailing Address
First Line	:	2153 N KING ST
Second Line	:	STE 322
City	:	HONOLULU
State	:	HI
Zip	:	96819-4559
Country	:	US
Telephone Number	:	808-848-8880
Fax Number	:	808-848-8814

Provider Business Practice Location Address
First Line	:	2153 N KING ST
Second Line	:	STE 322
City	:	HONOLULU
State	:	HI
Zip	:	96819-4559
Country	:	US
Telephone Number	:	808-848-8880
Fax Number	:	808-848-8814

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	07/08/2007

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