Healthcare Provider Details

I. General information

NPI: 1083505358
Provider Name (Legal Business Name): SOPHIA REIKO IWASAKI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-211 PALI MOMI ST STE 715
AIEA HI
96701-4339
US

IV. Provider business mailing address

5881 KALANIANAOLE HWY
HONOLULU HI
96821-2331
US

V. Phone/Fax

Practice location:
  • Phone: 808-437-2277
  • Fax:
Mailing address:
  • Phone: 808-366-2720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDT-3244
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: